Normally, the upper eyelid follows a concave curve from the inside to the outside above our eyes. The eyelid covers the upper part of the round, black portion called the cornea by about 1 mm from above. Ptosis, which is the dropping of the upper eyelid by more than 1mm for various reasons, is referred to as eyelid ptosis. Ptosis can be congenital or can occur after a certain age. When it occurs unilaterally, it can be quite noticeable and bothersome to individuals. Ptosis is essentially a group of diseases and can be classified into five groups based on the different ways the muscle that lifts the eyelid is affected.
- Myogenic Ptosis: Primarily caused by insufficient elongation and contraction of the muscle that lifts the eyelid. It is further divided into four subgroups:
- Congenital Myogenic Ptosis (Blepharophimosis Syndrome, Marcus Gunn Jaw-Winking Ptosis)
- Chronic Progressive External Ophthalmoplegia
- Myotonic Dystrophy
- Myasthenia Gravis
- Aponeurotic Ptosis: In this group of ptosis, the muscle that lifts the eyelid is intact, but there is separation of the muscle from the tissue it is attached to. It can occur due to aging, trauma, post-eye surgery, thyroid disease, and sometimes from birth.
- Neurogenic Ptosis: Caused by problems in the nerve of the muscle that lifts the eyelid. Conditions such as encephalitis, meningitis, certain brain diseases, trauma, or some metal poisonings can be the cause.
- Mechanical Ptosis: Drooping of the eyelid occurs due to the presence of some benign or malignant tumors on the eyelid. Ptosis can also develop due to poor wound healing following trauma.
- Pseudoptosis: Also known as false ptosis, this condition does not involve actual drooping of the eyelid. It is characterized by the eye appearing smaller or receding. This can occur in individuals using prosthetic eyes or with ill-fitting prosthetics.
How is ptosis surgery performed?
Ptosis surgery can vary depending on the many causes mentioned above. Finding the cause after examination and tests is the top priority. Treatment is then tailored to the cause. Generally, local anesthesia is preferred for adults, while general anesthesia is used for children. There are two types of surgery, open or closed, but the choice depends on the cause of the disease.
When does improvement occur after surgery?
After surgery, there is usually no need for the patient to stay in the hospital. If an open surgery was performed, the stitches are removed one week after the surgery. Swelling and bruising of the eyelid can be seen for about one to ten days. Approximately one month after the surgery, the eyelid should be completely restored and functional.
Does eyelid ptosis recur?
It depends on the cause of the disease, but generally, if complete improvement is achieved after the initial surgery, recurrence is unlikely. However, sometimes the desired result cannot be obtained with a single surgery, and a second surgery may be required. Occasionally, in the early postoperative period (typically within a week), the muscle that lifts the eyelid may detach from its surgical attachment point. In such cases, a corrective procedure should be performed as soon as possible.