· For some people, all a doctor will need to do is perform a physical examination. The drooping is obvious in these cases, so no further diagnostic tests are necessary. However, if the doctor suspects that a medical condition may be the underlying cause, further testing may be needed. During the evaluation, the doctor may take photos of the person, so they can compare them in the future to determine treatment success or ptosis progression.
· If further eye testing is necessary, a slit-lamp examination might be considered. The doctor usually puts a dye into the eyes and may also use another medicine to dilate the pupils. The doctor may perform this test to examine different eye structures, including the conjunctiva, eyelids, lens, cornea, iris, and sclera.
· Peripheral vision loss can occur with different brain and eye disorders. Visual field testing is a way to measure someone’s peripheral vision. In most cases, the doctor has the person cover one eye. With the other eye, they focus on something in front of them. The doctor them asks them what they see on the edges of their visual field.
· The Tensilon test may be considered if myasthenia gravis is the suspected cause of someone’s ptosis. For this test, the person receives the medicine Tensilon. If this drug makes the person’s muscles stronger, they have a positive Tensilon test.
There are two primary ptosis surgery techniques doctors use. The type of ptosis a person has and the degree of drooping play a role in deciding which technique is the best option.
With the general technique, there are two approaches the surgeon may use, including an external approach and an internal approach.
The external approach
The external approach is also referred to as levator advancement. When the person has a high upper eyelid crease and normal levator function, this is the most commonly used technique. The procedure happens as follows:
- The surgeon cuts into the eyelid skin.
- They take the levator muscle attachment and reposition it so it is attached to the tarsus.
- Sutures are used to keep the new position of the levator muscle.
This helps to raise the eyelid, so the drooping is not as apparent. People are not put to sleep for this procedure, but they do get sedation to ensure comfort.
The internal approach
The internal approach is another technique the doctor might consider when a person has strong levator function. With this technique, the eyelid is turned inside out. The surgeon then shortens the eyelid muscles. This may include shortening either the Mueller’s muscle or the levator muscle, depending on which one is contributing to the drooping. The surgeon usually focuses on the levator muscle when the person needs more of a lift for their eyelid. The Mueller’s muscle is targeted when only a subtle lift of the eyelid is necessary. For this procedure, the doctor will administer either sedation or general anesthesia.
The sling technique is also called frontalis sling fixation. This procedure may be considered when someone has poor muscle function and ptosis. This is typically seen with neurogenic ptosis, congenital ptosis, or myogenic ptosis. For this surgery, the frontalis muscle and the upper eyelid are attached to each other. The point of attachment is just above the eyebrows. A small silicone rod is usually used to attach the two structures together. It goes below the skin and is passed through the eyelid. In most cases, people who have this surgery are given general anesthesia. This is because the sling technique is a bit more involved that the general technique. Both adults and children can have this surgery. Following the procedure, patients may not be able to fully close the eye. This effect can last for up the three months, but it typically resolves.
Timeline for Recovery from ptosis surgery
It can take up to three months for someone to fully recover from ptosis surgery. This is the timeline for both of the primary surgical techniques. The following describes what you can expect during recovery:
- For the first three days, patients should ice the area according to the doctor’s instructions.
- Four to six times daily until the sutures are removed, the area should be cleaned per the doctor’s instructions.
- About a week after surgery, the sutures are typically removed.
- It is generally recommended that people take up to 10 days off work to rest.
- Exercise can usually resume in approximately three weeks.
- At the two-month mark, minimal swelling is still possible.
- At the three-month mark, the person should be fully healed.
During recovery, it is important to be patient because the eyelid position will change due to the swelling that is normal after surgery. It may be three months before the final position of the eyelid is realized. After three months, the doctor will evaluate the eyelid and determine if the person is happy with their results. If not, there is the possibility that revision surgery is possible to improve the results. In many cases, revision surgery consists of a few small adjustments. The surgery is typically not extensive. For some people, the ptosis surgery technique used for the first procedure can be repeated to enhance the results.
Tips to Promote Recovery
When a person has any eye surgery, there are certain things to avoid and some things to do that will promote recovery. Follow these tips and any other advice provided by your doctor:
- Follow all post-surgical instructions provided by the doctor.
- Use ice packs as recommended.
- Avoid heavy lifting, straining, and swimming for the recommended time period.
- Avoid smoking.
- Do not wear contact lenses until the doctor says it is okay.
- Keep your head raised while sleeping for a few days.
- Avoid blood-thinning medications for approximately one week.
- Clean the surgical site per the doctor’s instructions using only approved cleansers.
- Do not smoke.
- Do not rub the eyes.
- Wear sunglasses to protect the eye area.
Risks of ptosis surgery
The risks of ptosis surgery include:
- Unusual bruising or swelling after surgery
- Need for adjustment or additional surgery
- Asymmetric eyelid height
- Overcorrection or undercorrection
- Dry spots requiring lubricants
- Stiffness of the eyelid in downgaze
- Need to have the eyelid lowered if intolerant of having the eyelid opened