Ptosis Correction (Adults)

This leaflet has been produced to provide information for patients requiring surgery to correct a droopy upper eyelid.

What is ptosis?

Ptosis is a droopy upper eyelid. Sometimes the problem is mild and largely cosmetic, but in more severe cases the lid margin can cover part of the pupil and block the upper part of the vision. In such cases, patients tend to tilt their head back, overuse their forehead muscle or physically lift the eyelid with a finger, in order to see clearly.

What causes ptosis?

Rarely, the problem is present from birth (congenital) and is usually due to a poorly developed eyelid lifting muscle (levator muscle). It is more common in adults, when it is usually due to thinning and stretching of the levator muscle (eyelid lifting muscle) as part of the aging process. Other causes include long term contact lens wear, trauma and, rarely, tumour or neurological problems, such as a nerve palsy or muscle weakness.

Do you need ptosis surgery?

There are strict criteria for ptosis surgery. The need for surgery will depend on the severity of your ptosis and how much it affects your vision. Cosmetic surgery is not available on the NHS.

The surgeon not only examines the eyelids but also assesses your eyes to determine the precise nature of the ptosis and your suitability for surgery. Various measurements are taken including the degree of droop and how well the eyelid muscle works. You will also need a visual field test to prove that your vision is affected by the droopy lid. Depending on the examination findings, you will be advised on whether you are suitable for surgery and exactly which procedure is required. Surgery is best avoided in some cases.

What does the surgery involve?

In adults, ptosis surgery is usually performed under local anaesthetic as a day case. Local anaesthesia has the advantage of enabling a more careful adjustment of the eyelid height at the time of surgery, which leads to a more predictable result.

We numb the surface of your eye with local anaesthetic eyedrops and inject a small amount of local anaesthetic into your upper eyelid skin to numb the area. We then make a small incision in the natural skin crease and your eyelid raising muscle is exposed and shortened in order to lift the eyelid. Occasionally, the incision may be made on the inside of your eyelid to gain access to the lid-lifting muscle. The height and shape (contour) of your eyelid may need adjustment during the surgery for an optimal result. We use self-dissolving stitches to attach the muscle and close your eyelid skin. On average the operation takes 45 minutes to 1 hour for each eye.

Post-operative care

A double eye pad is usually applied overnight as a pressure dressing to limit swelling and bruising. If both your eyes are done simultaneously, one or both eyes will usually be left open and ice packs will be applied to the uncovered eye(s) to reduce your eyelid swelling which varies and usually lasts 10 to 14 days.

You can shower normally, but the wound should be carefully dried. You will be prescribed antibiotic ointment to apply on the stitches and lubricating drops and/ or ointment in your eye for a fortnight. You should be able to drive the next day if your vision is unaffected, but the ointment may temporarily blur your vision, so exercise caution when driving. The stitches are self-dissolving but are often removed at the first visit after surgery which takes place after one week.

What are the risks/complications of ptosis surgery?

• Excessive bleeding, bruising and swelling of the eyelids. Blood-thinning drugs such as warfarin, apixaban, aspirin and clopidogrel will increase the risk of bleeding and bruising and may need to be stopped before surgery. However, you should consult your GP and/or cardiologist before stopping your medication, to confirm that it is safe to do so.

• There is a small risk of infection of the eyelid wound, which is minimized by use of antibiotic ointment.

• The risk of over-correction (eyelid too high), or under-correction (eyelid still too low) is minimized by local anaesthetic surgery. A mild degree of overcorrection often improves after removing the eyelid stitches and tugging on the upper lid lashes to stretch the eyelid. More severe overcorrection may require further surgery. Significant under-correction, or late recurrence of the eyelid droop may also require further surgery.

• Because the eyelid muscle has been shortened, the eye may not close fully and is at risk of drying due to exposure. Lubricant drops and ointment help to prevent excessive drying, which usually resolves quite quickly. If the eye is very dry and your vision is threatened, the eyelid may have to be surgically lowered to protect the eye.

• The shape (contour) of the eyelid and the skin crease may need further adjustment if cosmetically unsatisfactory

• Sometimes operating on a droopy lid may unmask a tendency for the opposite side to droop, making subsequent surgery on the other side necessary.

Medication

Please bring a list of all of your medicines or a current repeat prescription from your GP with you to hospital.

You will be given some antibiotic ointment with advice on how to apply it to the operated eye(s) and wound(s) for two weeks after the operation. You may need to use paracetamol for a few days after the operation if the eye or wound is uncomfortable.

Contacts and further information

Please contact the theatre bookings team in the Eye Department on 01223 274863 if you have any queries regarding your appointment for surgery. For urgent post-operative concerns please contact the Emergency Eye Service on 01223 217778.