Ptosis (Drooping Eyelid)
What is ptosis (blepharoptosis) or droopy eyelid?
Eyelid ptosis affects the upper eyelid causing drooping of the lid, which affects appearance and can obstruct vision. Ptosis is the condition where the upper eyelid tendon (called the aponeurosis) that attaches to levator muscle stretches out, so that the muscle cannot fully lift the eyelid. Most upper eyelid ptosis is caused by aging. The result is drooping of the upper eyelids that interferes with vision.
Additionally, hooded eyelids caused by excess eyelid skin can hang over the eyelid margin and block vision. When that is the case, patients can benefit from blepharoplasty performed by an oculoplastic surgeon.
Ectropion is drooping or out-turning of the lower eyelid that exposes the inside of the eyelid and the cornea, causes eye redness, excessive dryness, irritation and sensitivity to light. Tearing is the main symptom. It is caused by aging of the muscles and ligaments that support the lower eyelid. Surgery involves removal of a small part of the lower eyelid at the outer edge and tightening of the muscle and ligament. Then, the lid is stitched back together.
What causes ptosis?
- Damage to the nerves that control the eyelid muscles
- Damage to the levator muscle
- Previous eye surgery
- Congenital ptosis due to poor development of the levator muscle
When is ptosis surgery indicated?
Ptosis surgery is indicated when vision is compromised by droopy upper eyelids. The surgery is called levator advancement.
What are the symptoms of ptosis?
Common complaints include:
- Raising your eyebrows to open your eyes
- Loss of peripheral vision
- Looking through the eyelashes
- Difficulty driving, reading, walking
- Discomfort and headaches
- Tipping back the head to see under droopy eyelids
- Physically lifting the eyelids with the fingers or forehead muscles to improve visual acuity
- One or both eyes can be affected
What is levator advancement?
Levator advancement is ptosis surgery to elevate the upper eyelid margin by tightening the levator tendons to allow the levator muscle to elevate the lids to a normal level.
What is the procedure?
The operation is performed under local anesthetic because the surgeon needs the patient to be awake to help the surgeon determine the best position for the eyelids. Sedation may be used. An incision in made in the natural crease of the eyelid. The tendon is tightened with stitches and the wound is closed. The stitches are usually absorbable. When the muscle is abnormal, it may be tightened or shortened. If the levator muscle is very weak, the forehead muscle will be used to lift the eyelid.
The goals of surgery are:
- To position the lid at a normal level that matches in both eyes and retains the natural contour of the lid, so that the lid can close completely and is comfortable
- To enlarge the field of vision
- To improve the quality of vision
- To restore normal lid appearance
You will be sent home with eye drops and ointments and should prepare for a week off work, but you can drive within a few days.
Levator advancement will tighten the upper eyelid muscles to physically elevate the upper lids and is performed at the same time that excess skin and fat are trimmed for cosmetic improvement.
Insurance coverage for levator advancement
Levator advancement is performed for medical reasons. It is often combined with an eyelift to remove excess tissue at the same time of repair to the lax tendons and muscles to correct ptosis that impairs your vision and may be covered by your insurance. If sought to primarily improve your appearance it will not be covered by insurance.
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