Ptosis Surgery

In most cases, a drooping upper eyelid results from aging of previously normal structures. Typically, the tendon that attaches the "lifting" muscle to the eyelid stretches and the eyelid falls too low.

Since the muscle that lifts the eyelid has normal strength, surgical correction of a drooping upper eyelid that was once normal involves repairing the stretched tendon. Causes of the droopy eyelid may be damage to nerves that direct the muscles that lift the eyelid, or the muscle itself. Occasionally a rare condition that affects the connection between the nerve and the muscle may cause intermittent droopiness.

When a droopy eyelid is causing problems with vision, such as limitation of the top part of your visual field, or even blocking the central vision when the pupil is covered, treatment may become necessary. Other reasons for treatment may be cosmetic.

The surgery aims to correct the top eyelid position to a desired level. This is not always possible as there may be factors that will prevent a safe lifting of the eyelid. That is why it is important to assess before the operation what level of the eyelid will not result in major eye problems. The operation is normally done with a local anaesthetic, sometimes with mild sedation.

Most of the time it is possible to shorten the tendon of the muscle that lifts the eyelid, but sometimes it will be necessary to "connect" the eyelid indirectly to the eyebrow to enable the eyelid to be lifted.

Ectropian Repair

An ectropian is an outwardly turned eyelid. The condition most often is associated with ageing, though it may also occur congenitally, as a result of scarring or other surgeries, or secondary to facial nerve paralysis (Bell’s palsy). If not repaired, the condition may lead to thickening of the mucosal surface on the inside of the eyelid (conjunctiva) with consequent inflammation of and danger to the health of the eye itself.

Usually only a few stitches are placed in the skin at the lateral corner of the eye, and these are often removed 7 to 14 days later. There is typically almost immediate resolution of the condition. Most patients have little if any discomfort with the procedure. There may be mild bruising and swelling following the procedure. This should resolve within about two weeks.

Entropian Repair

An entropion is an inwardly turned eyelid. The condition occurs primarily as a result of advancing age with consequent weakening of certain eyelid muscles. The imbalance between eyelid muscle groups results in the inward turning of the eyelid. The condition almost always affects the lower, rather than the upper, eyelids.

Repair of involutional entropion (associated with ageing) may be completed with a variety of procedures. Most cases are completed with an incision in the lateral corner of the eye or an incision just beneath the lower eyelashes. In either case, a tightening of tissues is required to resolve the imbalance between the muscle groups of the lower lid.

Most patients experience immediate resolution of the problem once surgery is completed with little if any post-operative discomfort. Most cases will require subsequent removal of sutures located along the lower eyelashes or the lateral corner of the eyelid. Minor bruising or swelling may be expected and will likely resolve in one to two weeks following surgery.