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Acquired Ptosis

What is an acquired ptosis?

Ptosis (pronounced tosis) is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes.  Ptosis that presents itself after childhood is called an ‘acquired ptosis’.  When the edge of the eyelid drops and covers part of the pupil it blocks the upper part of your vision.  In severe cases, it is necessary to tilt one’s head back or lift the eyelid with a finger in order to see out from under the drooping lid.

What causes an acquired ptosis?

In most cases an acquired drooping of the upper eyelid results from the ageing of the eyelid.  Typically the tendon that attaches the ‘lifting’ muscle to the eyelid stretches and the eyelid droops low.  Occasionally the condition results from other general conditions such as Myasthenia Gravis (MG), chronic progressive external ophthalmoplegia (CPEO), III^rd nerve palsy and many others.  Your eye specialist may mention it to you if necessary.

What is the treatment and how is it done?

The treatment depends upon the cause.  Common causes of ptosis (drooping) like age related, congenital etc are amenable to surgery.  The treatment involves an operation to lift the eyelid and it is usually carried out under local anaesthetic as a day case with or without sedation.  Local anaesthetic eye drops are used along with an injection into the upper eyelid to numb the area.  We usually use dissolving stitches at the site of the operation.  Drooping (ptosis) of the eyelids related to medical conditions (MG, CPEO III^rd nerve palsy) require a multidisciplinary approach.

What to expect after the operation?

A dressing may be applied for 24 hours.  The upper eyelid will usually appear swollen and bruised which tends to subside over 7-10 days, in some cases it may take longer.  Make sure the wound is kept clean and dry.  There should be very little discharge from the wound and if necessary, you may clean it using cooled boiled water and clean cotton wool or tissue.  Use a separate piece of cotton wool or tissue for each wipe to the area.  You will be prescribed some lubricating eye drops and antibiotic ointment – please use as directed.

Are there any risks or side effects?

·    There may be bruising and swelling around the eye.

·    There is a small risk of infection of the eyelid or the eye.

·    There is a possibility of under or over correction of the eyelid, which may require further operations.

·    There is a possibility of inability to close the eyelids permanently.

·    Sometimes if your other eye has a tendency to droop, it may be more noticeable after this operation.  Your eye specialist may warn you of this possibility, where applicable.

 What are the benefits?

    ·    Restoring normal appearance of the eyelid.

·    Improved upper part of your vision and improved quality of vision where the pupil was previously occluded by the droopy upper eyelid.