Ptosis and its Corrective Procedures
What is Ptosis?
Dropping of the lid is known as ptosis. It can be corrected surgically with different procedures after detailed ophthalmic and systemic evaluation. It is the name given to the abnormally low position of the upper eyelid, which can prevent the eye from seeing as well as it should; often resulting in a lazy eye or amblyopia. The reason that it has occurred is due to a weakness in the muscle that lifts the upper lid eye called the levator palpebrae.
Why does my child need ptosis surgery?
Ptosis surgery aims to strengthen the little muscle that lifts the upper eyelid. There are a number of different approaches to achieve this. Occasionally if the muscle is too weak, the forehead muscle may be used to help lift the upper eyelid, this is called a frontalis suspension procedure.
Ptosis surgery may be required due to one or more of the following:
- Reduced vision in the affected eye which may result in a lazy (amblyopic) eye
- Excessive drooping of the upper eyelid with or without resultant headaches
- Reduced field of vision, which may result in abnormal head posture
- Unacceptable appearance of eyelid
Are there any risks involved in this operation?
There are some risks associated with anesthesia, which are common to all operations. Serious complications are very rare. Infection is a rare postoperative complication following surgery although every precaution is taken to prevent this. The commonest complications associated with this operation are overcorrection (eyelid is too high) or under correction (still too low). Incomplete blink may occur following surgery and the child may sleep with the eye open for up to 2 weeks after the surgery. These resolve with time following the operation. There is a risk of corneal exposure with discomfort and possible corneal ulcers although this is unusual in children. The aim of the surgery is to have the upper lid in a good position when the child is looking straight ahead, you may notice more white (sclera) of the eye on show when the child looks down. This is to be expected following the surgery, as the upper lid will not follow the eye in the down gaze position. However, over time this will become less noticeable. Despite these potential complications, it is worth remembering that there are benefits to be gained by having the surgery. The benefits and risks should be discussed with the the eye surgeon.
Will the operation be painful?
Local anesthesia is given to the eyelid and the brow at the time of surgery, and there should be no discomfort. There may be some discomfort in the postoperative phase which should be resolved with mild painkillers, such as paracetamol. How long will my child be in hospital? Your child will be admitted to the pediatric surgical recovery on the day of surgery and can go home the same day.
How long will the dressing stay in place?
We usually find that the child will not tolerate a dressing over the operated eye, and therefore we often do not put one on. We may use a plastic shield called a cartella or eye pad to protect the eye until the child has fully recovered. This shield can be used at night, if tolerated.
How long will it be before my child can return to school?
This will depend on your child’s recovery, but we would suggest that the child should stay off school and sports for at least 2 weeks.
What instructions will I be given following my child’s procedure?
You will be asked to apply an antibiotic ointment to the operated site and inside the operated eye 3 times a day for 2 weeks. You will be informed by the nurse taking care of your child when your follow up appointment is due. The bruising will take 2-3 weeks to resolve. Your child will need to be followed up by the Paediatric Ophthalmology Service and so often multiple appointments are required to improve the vision in the eye following the surgery. This may involve patching or spectacles.
