Ptosis Repair

Ptosis repair is the adjustment of the eyelid so as to improve eyelid drooping. The procedure may be required on one or both eyes depending on patient characteristics. The excess skin in the upper eyelids can be removed surgically by a procedure called blepharoplasty. It improves side vision and other symptoms. Removal of the excess skin in either the upper or lower eyelids may improve appearance.

Ptosis Resources About Your Visit Certificate of Need Form Surgery Pre-Post Operative Instructions Before & After Pictures of Ptosis Repair

Ptosis may be congenital or acquired as a result of paralysis, neurogenic, trauma or aging. Classic signs characterized by drooping of the eyelid with or without lavator disinsertion.

Symptoms

Drooping of eyelid may be constant or intermittent, or occur with use. In levator dehiscence, the ptosis is constant and worse in downgaze. In neurogenic ptosis, the defect may be at the level of the neuromuscular junction, the third cranial nerve nucleus or peripheral nerve or the sympathetic chain. In myasthenia gravis, the symptoms are variable and aggravated with use. The ptosis is constant without significant variation in patients with a third nerve palsy, Horner’s syndrome, or levator dehiscence.

Risk Factors

Prior eyelid surgery, trauma, eye rubbing

Management

Depends on cause. Myasthenia gravis: oral prednisone with or without Mestinon. Always involve a neurologist before initiating therapy. Third nerve palsy: do strabismus surgery prior to considering ptosis repair to avoid symptomatic diplopia that requires patching. Complete third nerve palsy is difficult to manage; observation rather than surgical intervention is wise. Horner’s syndrome: internal conjunctival –Muller’s resection can be effective.

Pharmacology

Neosynephrine drops can be used pre-operatively to help guide the selection of surgical approach. The posterior (conjunctival-Mueller’s excision) approach is only effective if Neosynephrine results in elevation of the eyelid to normal height.

Before & After Picture

Bilateral Upper Eyelid Blepharoplasty & Ptosis Repair

Ptosis Repair