How is ptosis defined?
The normal upper eyelid margin lies about 3 to 4 mm from the centre of the pupil. When this distance drops to 2 mm or lower, the patient has ptosis of the upper eyelid. This is also known as blepharoptosis.
What are the causes of ptosis?
The most common cause is age-related or senile ptosis where the levator muscle that lifts up the eyelid is either stretched excessively or has become detached from the lower portion of the eyelid known as the tarsal plate. This disturbance in the levator muscle can also be seen sometimes in younger patients who have worn contact lenses, suffered trauma to the eyelid area or had previously undergone some other eye surgery.
Other causes of ptosis include neurological conditions such as a third cranial nerve palsy, Horner’s syndrome or myasthenia gravis. Ptosis can also be congenital. A good clinical examination and, if necessary, specific tests, will allow your oculoplastic surgeon to identify the cause of the ptosis.
Am I a good candidate for ptosis correction?
Like blepharoplasty, there are two types of ptosis repair: cosmetic ptosis surgery and functional (medical) ptosis surgery. Both aim to elevate the upper eyelid.
Cosmetic ptosis surgery is performed when the degree of age-related ptosis is mild. This means the distance between the upper eyelid margin and the centre of the pupil lies between 2 and 3 mm. In these cases, insurance and Medisave will not cover the cost of the surgery as there is no medical reason to require surgery. Often, surgery is performed for cosmetic reasons only.
Functional (medical) ptosis surgery helps to increase the superior visual field when the upper droop is more pronounced. The distance between the upper eyelid margin and the centre of the pupil is less than 2mm. Both photographic and perimetric (visual field) evidence are required before one is allowed to claim insurance or use Medisave to pay for the surgery.
If one has noted drooping of the upper eyelid and has been troubled by it, then one could consider ptosis surgery. A detailed examination by your oculoplastic surgeon will help to rule out other more serious causes and allow a determination of the severity which would determine whether one could claim insurance or utilize Medisave for the surgery.
Is revision surgery a common occurrence?
Like blepharoplasty, revision surgery is occasionally encountered in ptosis surgery. Even when the same technique is employed by the same surgeon on both sides, asymmetry and other complications can occasionally be encountered. It is good to know that a slight adjustment of upper eyelid height or contour or a refinement of the crease in the early post-operative period is not considered revision surgery but rather a fine-tuning of the main procedure.
How much down time will I encounter?
Most eyelid surgeries will heal within two weeks. Stitches are removed between one to two weeks. Some bruising may still be evident at the end of two weeks but is not a major concern. As patients show a variable rate of healing, it is best to dedicate two weeks of rest to allow for good post-operative care and optimal healing. Travel overseas is best avoided during the post-operative period as any troublesome problem, even if small, is best managed by your surgeon.