Ptosis Repair
What Is Ptosis?
Ptosis of the eyelid occurs when the upper eyelid is not open as wide as it should be, creating a droopy or sleepy look. Ptosis can affect one or both eyelids and can be categorized as mild, moderate, or severe. With mild ptosis, the eyelid droops downward near the pupil, or the black circle that lets light into the eye. With more severe ptosis, the eyelid completely covers the pupil. Depending on the severity, ptosis can affect vision by making vision seem less bright and blurry or reducing the upper field of vision. Reading is often affected because the eyelid droops down further when you look downward to read. If vision impairment is caused by ptosis, it should improve when you lift the eyelid upward with your finger. Dr. Langelier’s approach to ptosis repair in Richmond allows patients to restore healthy and aesthetically pleasing function to the eyelid.
What Causes Ptosis?
Ptosis occurs when something keeps the eyelid from opening as wide as it should. Two main eyelid muscles allow the eyelid to open. The levator muscle does most of the lifting and is what allows us to open our eyelid when it is shut. The Muller muscle opens the eyelid an additional two millimeters—this muscle is turned on by adrenaline in our body and is the muscle that makes our eyes pop open wide when we are startled.
Involutional Ptosis
Involutional, or aponeurogenic ptosis, is the most common cause of ptosis and occurs when age, wear, and tear cause the muscle or its tendon to stretch out. If you think about this muscle as a pulley, involutional ptosis is like a stretched-out pulley that still works but doesn’t open the eyelid as wide as it used to. Risk factors for involutional ptosis include genetics, age, side sleeping, eyelid rubbing, and contact lens wear.
Mechanical Ptosis
Mechanical ptosis occurs when something is pulling on the eyelid, causing it to droop. A growth like a large eyelid skin cancer can weigh the eyelid down and cause ptosis. Scarring from prior trauma can cause the eyelid to be tethered and not open properly.
Before & After
Congenital Ptosis
Congenital ptosis is a droopy eyelid that starts at birth. With congenital ptosis, the muscle itself is weak and stiff. It is important for a child born with a droopy eyelid to have a prompt eye exam to make sure the eyelid is not blocking the eye from seeing. Blocked vision in a baby or young child can cause long-term, permanent problems with vision development, which is called amblyopia. If there is a concern for amblyopia, the eye doctor will recommend prompt repair of the droopy eyelid. If the droopy eyelid is not affecting vision development, the droopy eyelid can often be monitored. Then, surgery can be performed at the family’s discretion when the droop becomes bothersome visually or socially.
Neurological Causes of Droopy Eyelids
Neurologic conditions can also cause ptosis of the eyelid. Neurologic causes of ptosis often have signs and symptoms other than just a droopy eyelid. Causes of neurologic ptosis include but are not limited to Horner syndrome, third nerve palsy, and myasthenia gravis. You should have your ptosis evaluated urgently if it occurs suddenly, or if you also have double vision, a severe headache, pupils that are different sizes, weakness, difficulty swallowing, or facial pain. Further testing may be needed, including CT, MRI, and lab testing.
How Is Eyelid Ptosis Treated?
Surgery is the most common treatment for eyelid ptosis. There are three main surgical techniques for correcting eyelid ptosis.
External Levator Advancement
The most common treatment for ptosis is called external levator advancement or levator aponeurosis advancement. This procedure involves making an incision in the eyelid fold and tightening the main muscle that opens the eye (the levator muscle). The main goal of ptosis surgery is to open the upper eyelid wider to improve the field of vision. Ptosis repair is achieved in an outpatient setting using local anesthesia with an option for light sedation. After tightening the muscle, Dr. Langelier will often ask her patient to open their eyes so that she can check the eyelid height, contour, and symmetry. This gives her an opportunity to adjust the eyelid during surgery to achieve the most desirable result.
Muller Muscle Conjunctival Resection
If the levator muscle is weak or if there is only a small amount of ptosis, a technique called Muller muscle conjunctival resection may be used. This surgery is performed on the underside of the eyelid to tighten the Muller muscle.
Frontalis Sling Technique
If both the levator muscle and the Muller muscle are weak, a third technique called a frontalis sling can be used. This surgery uses a sling to attach the upper eyelid to the forehead muscle near the eyebrows. After surgery, when the eyebrows are lifted, the eyelid opens wider. The sling can be made of many different materials, including silicone, gortex, and even your body’s own tissues. This is an excellent option for patients whose droopy eyelid blocks their vision and whose other muscles of the eyelid do not work well.
Alternatives to Surgery
Alternatives to surgery include observation (doing nothing). Certain eyedrops can improve the appearance of ptosis for a few hours, but it is not a cure. When used too frequently, these eyedrops can cause eye redness or irritation. Dr. Langelier recommends only using them for special occasions.
What Is the Success Rate and How Long Does My Result Last?
Since ptosis repair includes operating on abnormal muscles, many variables may affect the outcome of your ptosis repair. There is always a possibility that the eyelid will be placed higher or lower than desired or that the curve and shape of the eyelid turn out differently. Touch-up surgery to improve eyelid position may be necessary. While perfect symmetry between the two eyelids can never be guaranteed, the vast majority of patients see a great improvement in their eyelid position and are happy with their results. Dr. Langelier’s technique for ptosis repair aims to provide a long-lasting result. However, genetic predisposition, continued aging, side sleeping, contact lens wear, and frequent eye rubbing can cause the muscle to stretch out again. If recurrence occurs, in most cases, the eyelid can be operated on again, but avoiding side sleeping and eyelid rubbing is advised to help maintain your results.
When Should I Consider a Ptosis Repair?
You should consider undergoing a ptosis repair if you experience:
- Difficulty keeping your eyes open
- Headaches or forehead strain that happens when trying to keep your eyes open wide to see
- Eye fatigue, especially when reading
- You see better when you lift your eyelid open wider with your finger
- You have a drooping eyelid and do not like the appearance
Schedule a Consultation Today
Finding the right surgeon for ptosis repair in Richmond starts with a consultation. Meet with Dr. Langelier personally to discuss your options and build a tailored treatment plan.