Blepharoptosis
Blepharoptosis (-ptosis) (blef´a-rō-tō´sis) drooping of the upper eyelid
THE CONDITION
Blepharoptosis (often referred to as “Ptosis”) occurs when the upper eyelid lid fails to fully open. Blepharoptosis can be present at birth but more commonly develops later in life. The cause is usually either weakness of the eyelid opening muscle or loosening of the muscle from its attachment inside the eyelid.
BLEPHAROPTOSIS IN CHILDREN
Children with ptosis may develop a secondary condition known as amblyopia. If a child’s brain never receives a clear visual image from the eye, it may fail to develop the ability to detect a clear image, effectively causing lifelong reduction of vision. This condition is known as amblyopia. Amblyopia may be caused by other conditions also. It is important to detect amblyopia from blepharoptosis or other causes and correct both the amblyopia and the condition that caused it. When caused by blepharoptosis it is important to undertake blepharoptosis repair.
BLEPHAROPTOSIS IN ADULTS
Blepharoptosis that develops in teenagers and adults does not cause amblyopia. Blepharoptosis repair is performed to improve field of vision, reduce visual fatigue, and enhance cosmesis.
TREATMENT
Blepharoptosis repair is typically performed in an outpatient surgical setting. An anesthesiologist (MD) administers sedating medications while monitoring vital signs. The eyelid opening muscle is reattached or shortened through a small incision in the upper lid.
Less commonly, the eyelid opening muscle is too weak to resolve the droopiness by the above technique. When this degree of muscle weakness is present, frontalis sling must be performed. This involves connecting the eyelid to the eyebrow (frontalis) muscle deep within the eyelid tissues.
INSURANCE COVERAGE
Depending on severity of the ptosis and associated vision problems, insurance companies usually authorize ptosis repair.
POSTOPERATIVE HEALING:
The postoperative healing experience is relatively straightforward:
In General:
A driver is required to travel home. Patients do not feel “laid up.” We ask patients to relax, stay home, and use cold compresses on the eyes for two days. Significant bruising frequently occurs. This can be expected to resolve within two weeks. Avoidance of strenuous activity is necessary for two weeks to avoid bleeding and wound disruption.
Specifically:
Pain Relief: Most patients do not experience postoperative pain beyond a modest headache in the first few postoperative hours. This is typically treatable with acetaminophen.
Cold Compresses: Intermittent use of cold compresses is very important the day of surgery and the day after. “The more the merrier” is our recommended approach for frequency and duration of cold compresses. However, when asked for specifics we generally recommend cold compresses twenty minutes per hour while awake on the day of surgery and somewhat less frequently the next day. We don’t find cold compresses useful after the second postoperative day. The most practical and cost-effective cold compresses, those we find to work best are bags or frozen vegetables placed on a clean washcloth over the eyes.
Bruising and Swelling: Both vary greatly between patients. Some people bruise and swell little while others develop very significant effects. Bruising may extend into the lower lids and occasionally spreads into the cheeks. It takes about two weeks for bruising and swelling to resolve. We ask all patients to plan social engagements around an expectation of significant bruising.
Caretaker: It is not necessary to have a caretaker after surgery, but it is recommended for the remainder of the surgery day.
Wound Care: Very little care of the wound will be necessary. We will not place patches on the eyelids. We don’t routinely recommend postoperative antibiotics. See sections on suture removal and bathing.
Activity: We ask patients to take it easy the day of surgery and the next day. Thereafter most activities may be resumed. However, for two weeks after surgery we ask that patients avoid activities that increase the blood pressure in the head as this can lead to bleeding. Activities to avoid include bending over so the head is below the heart, heavy lifting, and strenuous exercise.
Head Elevation: Keeping your head elevated above your heart while sleeping for the first two nights significantly helps bruising and swelling. We recommend an extra pillow in bed. Many patients choose to sleep in a recliner.
Bathing: We ask that the surgical wounds be kept dry for the first 24 hours after surgery.
Driving: We ask people to avoid driving for twenty-four hours after surgery in order to allow sedating medications to completely leave your system. This necessitates a driver to return one home from the surgery center.
Suture Removal: We usually use self-dissolving sutures. These resolve in about a week so no suture removal will be necessary..
Makeup/Skin Treatment Products: Makeup and skin treatment products may be used 48 hours after surgery.
Contact Lenses: Contacts may be worn on the first postoperative day as long as one can insert and remove the lenses without placing tension on the surgical wound. Generally, people avoid contact lens wear for four to seven days. We can demonstrate techniques to safely insert and remove contact lenses.
Returning to Work: We think it’s reasonable to stay away from work for two weeks. Most people return to work after a few days. Whether one returns earlier than two weeks is dependent upon one’s comfort with being seen with healing eyes, and the degree to which strenuous physical activity is required.
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