Importance of Diagnosing Drooping Eyelid Cause before Undergoing Ptosis Repair Surgery

Описание: A 25-year-old lady has a drooping eyelid which has been progressively becoming worse. Her family doesn’t recognize the difference. She wants to know if this is normal and the procedures that can help her eyelid.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon practicing for 20 years, has a background in eye surgery and plastic surgery of the eyes and face. Ptosis is something he deals a lot with in his practice. Most people have a difference of about 1-2 millimeters between the two eyes, which is why her family is not acknowledging an obvious difference. At the same time, when she takes photos or when she gets tired, a lot of those differences are obvious.

During evaluation, Dr. Prasad would ask patients to look at previous photos. There’s a condition called congenital ptosis which is when one or both eyes are drooping because of the development during gestation of a muscle that lifts the eyelid called the levator muscle. Someone may have symptoms of drooping eyelids that causes the eyelid to progress a little lower but they may also have some degree of drooping eyelid throughout their lives. In addition, any kind of trauma that causes the eyelid to swell can make it droop because of eyelid stretching. If that’s not the case, then he wants to also rule out any neurological causes, so an examination with an ophthalmologist, neuro-ophthalmologist or neurologist is needed to ensure the eyelid drooping is not a sign or symptom of something else that may need intervention other than surgery.

Normally, people have drooping eyelids as they get older because the tendon of the levator muscle called the aponeurosis tends to get thinner and detaches. This phenomenon is called involutional ptosis and is a very common problem as we get older. That’s an acquired ptosis and is probably the most common type of ptosis there is. However, this lady is very young for that type of situation. It is very important to establish whether or not this is congenital ptosis or if there is any other neurological reason for the ptosis. Once those things are ruled out, especially the systemic issues, then she can consider surgical options.

Typically, Dr. Prasad performs ptosis surgery under local anesthesia with LITE™ sedation which is a deceptively complex procedure. It is done in a very small space in the eyelid area where a very sensitive muscle has to be manipulated so that the eyelid height, shape and contour are symmetric with the other eye. There are situations when someone has one drooping eyelid, he physically lifts that eyelid during an examination and the other eyelid droops. That is one of the manifestations of Hering’s Law which has to do with the way the brain feeds the eyelids so that when you correct one, the other one will droop. He checks and decides whether or not it’s significant enough to do both eyes. He also does a proper evaluation of eye function in terms of how she blinks and how high her eye rolls to protect the eye when she is blinking. These are part of a standard ophthalmological examination.

During surgery, Dr. Prasad often let the patient sit up several times to evaluate what the eyelid level is relative to the effects of gravity. He lets the patient open and close their eyes during surgery. They never feel any pain and they are comfortable. This helps him predict the appearance of the eyes after the surgery is completed. Once surgery is completed, he basically does the same thing he does with other cosmetic eyelid procedures: cold compresses on the eyes, observe, and a week later he take stitches out.

Dr. Prasad suggests that she have an evaluation first by an ophthalmologist, possibly a neurologist to eliminate the other systemic causes of ptosis. Once that’s eliminated, then it’s time to then identify a doctor she feels comfortable with most likely an oculofacial/ oculoplastic surgeon who does a lot of ptosis surgery. Hopefully, this surgeon has a cosmetic sense that resonates with her. Ptosis surgery can really be very fulfilling and can restore the patient’s confidence about the asymmetry of their eyes.

For more information about ptosis correction surgery, please visit our website:

http://prasadcosmeticsurgery.com/pras...