Eyelid Ptosis

Ptosis (“toe-sis”) is the medical term for drooping. This is a separate issue from excess eyelid skin/dermatochalasis (which is addressed with a blepharoplasty). Ptosis occurs when the muscle that lifts the upper eyelid becomes loose. This may occur with age, after eye surgery (cataract, glaucoma or retina surgery), or with prolonged contact lens use. In rare cases, it may be a congenital condition.  Blepharoplasty (eyelid skin removal) surgery alone will not correct ptosis. The affected muscle in the middle layer of the eyelid must be addressed to correct the drooping eyelid. Dr. Hui will meet with you and perform a thorough exam. Many factors must be taken into consideration to determine the optimal ptosis repair procedure for you. After measurements are taken, together you will discuss the most appropriate treatment plan. If appropriate, ptosis repair surgery may be performed in conjunction with cosmetic blepharoplasty. Procedures are performed on an outpatient basis with minimal postoperative pain. Most patients resume their normal activities one week after surgery.

• Internal repair – In certain cases, the incision may be placed on the underside (inside) of the eyelid. The muscle is shortened from this inner surface to lift the eyelash line and restore the proper eyelid height and contour. This surgery is performed on an outpatient basis, usually with IV sedation to help you relax. 

• External repair – In some patients, an external skin approach is needed. The incision is hidden in the natural upper eyelid crease. The loose muscle is then isolated and internal stitches are used to elevate the drooping eyelid. This surgery is performed with the patient awake (IV sedation may be given if needed to relax you for parts of the surgery) so you may open and close your eye.  Your participation during this portion of the procedure helps Dr. Hui to place the stitches in the optimal location to achieve the desired result.

• Sling – When the eyelid opening muscle (levator) of the upper lid is not functioning in a normal range, a different approach must be undertaken. Poor eyelid function may be seen in congenital ptosis, congenital/acquired muscular dystrophies, myasthenia gravis, and after eyelid trauma. In these cases, we must recruit other muscles to help this poorly functioning levator. A sling may be used to harness the function of the forehead muscles to lift the drooping upper eyelid. Dr. Hui will help to determine the most appropriate type of sling to use in your case during this outpatient procedure.