Ptosis is the technical term for the drooping of an eyelid. Ptosis can occur in one or both lids, and can often cause vision obstruction. The causes of this condition can be credited to the aging process, prior surgery, or may be congenital in nature.
Although commonly fixed for cosmetic purposes, ptosis surgery is also indicated to resolve many non-cosmetic issues. This condition can often obstruct vision and affect a person’s ability to drive, read, or otherwise perform daily activities. Children with severe ptosis are at risk of altered development, and adults may experience a lesser quality of life due to a limited field of vision.
The need for ptosis surgery is examined by reviewing the symmetry of the middle part of the patient’s face. Eyelids are measured and photographs are taken of the position of the eyelids. Lids are carefully examined and often the patient’s field of vision is reviewed to determine the best treatment option.
Levator Tightening
In most individuals who have acquired ptosis from aging, the condition is caused by the gradual stretching of the upper eyelid tissue that slowly causes the eyelid to droop. This type of ptosis can be corrected by tightening the levator muscle that is responsible for raising the eyelid. An incision is placed in the normal crease of the upper eyelid and the levator muscle is then resectioned. This tightens the muscle and restores normal function to the eyelid, allowing it to lift to a proper level.
Frontalis Suspension
If a stretching of the tissue is not the cause, then a weak levator muscle may be to blame. This is often the case in congenital cases, but can occur both in early childhood and later in life. Early childhood cases of ptosis are often caused by improper development or muscular dystrophy. Other causes include eyelid tumors, muscular diseases or neurological disorders. If the levator muscle is weak, then tightening the muscle will not sufficiently remedy the issue, and a frontalis suspension is necessary to lift the eyelid to an appropriate position and restore normal function.
A frontalis suspension uses small strands of fibrous tissue that are surgically affixed to the eyelid and the eyebrow. This biological fibrous tissue can be taken from the individual’s own body (common in children), or from a donor. After the strands are placed, they are tightened to lift the eyelid into the correct position. When the patient lifts their eyebrow, the suspension will result in a lifting of the eyelid, restoring a normal field of vision.
Blepharoplasty
Blepharoplasties are best known as a cosmetic repair and are a very common procedure performed by plastic surgeons. This procedure removes the loose or baggy skin and fatty tissue around the eye that results from aging. When these folds of skin hang down or fatty tissue impedes lid lifting, it not only creates an aged appearance, but can also obstruct one’s field of vision. The issue of aging eyes and loss of vision due to baggy eyelids has become better recognized in recent years, and this procedure is much more commonly covered by insurance carriers.
These baggy eyelids are considered pseudoptosis, or false ptosis. The name comes from the fact that the patient has no issues with the strength or tightness of their levator muscle, but simply has too much skin or fat above the eyelid and therefore suffers from tissue overhang or impaired lifting abilities that restricts their field of vision. Some cases also result in eyelashes folding inward or outward, which irritates the eye itself.
Surgically removing this overhanging skin can improve a patient’s field of vision and also the function of their upper eyelid. Although this removal also causes a cosmetic improvement and an “awakening” of the eyes, the procedure to remove excess tissue around the eyes helps many individuals regain better vision.
Ptosis surgery is performed in different ways depending on the cause and severity of the condition. The specific surgery performed depends on the strength of the levator (lifting) muscle, the severity of the condition, the patient’s age, and if there is interference with the individual’s field of vision. Incidences of acquired ptosis are often treated with a different surgical procedure than congenital ptosis. Levator tightening, frontalis suspension, and blepharoplasties are all non-cosmetic cures for conditions that cause visual impairment.
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