Ptosis is falling or a dropping of an eyelid. The symptoms increase the longer you are awake because your muscles also become progressively more tired. If not treated in early childhood this condition can worsen an cause other sever eye related problems like amblyopia (sometimes called “lazy eye”) or astigmatism.
If someone is suffering from a more developed state of ptosis (aponeurotic and congenital for example) a surgical correction might be required if you want to retain your vision capabilities. Of course, there are several different methods and they are properly applied depending on the type of ptosis that you are suffering from. In most cases this is performed by ophthalmic plastic and reconstructive surgeon who has specialized in problems and diseases of the eyelid.
Different kinds of ptosis surgery
The Levator resection surgery is one of the most common types of ptosis surgery. There are numerous ways to go through this process but the two most common methods are those explained by Berke and Beard in their reports of congenital ptosis repair. Berke’s method incorporates upper eyelid excursion to estimate the intraoperative eyelid height at the end of the operation. The method explained by Beard uses both eyelid excursion and amount of ptosis to determine the proper amount of levator that needs to be resected. These methods are used when a patient has at least some amount of levator function left.
Müller muscle-conjunctival resection procedure is mostly used for those patients that are looking for an aesthetic correction. This surgery can be performed with or without blepharoplasty. After the completion of the preoperative evaluation it is important to choose only the patients that are appropriate for this treatment. In the past only patients with a mild (up to 2mm) ptosis were accepted but recent studies have shown that even candidates with moderate or moderate to severe ptosis can undergo the process. The eyelid crease incision can be decided specifically to every patient depending on their age, sex, brow position and anticipated prominence of the upper eyelid skin fold.
Frontalis sling operation is probably the simplest solution for this problem. It is actually a modified and simplified version of brow suspension technique. Using non-absorbable thread and only one skin incision this can treat cases of both mechanical and congenital ptosis and ptosis with Marcus Gunn phenomenon as well. There is no need for special tools as the Wright needle or the Reese ptosis knife. Because of that, it is also probably the most simple of all available methods. Of course, that doesn’t come without any drawbacks. Increased risk of lagophthalmos and lid lag in down gaze is something that needs to be taken into account. This is probably the reason why it is only used in some cases of mechanical ptosis, gross bilateral ptosis with poor levator function that is caused by the blepharophimosis syndrome and in severe unilateral ptosis covering the pupillary area. In the last case this is only a pre-operation to prevent amblyopia.
Still, make sure you use all the other options before deciding to go under the knife. Special Scleral contact lenses and “crutch” glasses can be used as a non-surgical way to support the eyelid. If your ptosis is caused by some kind of disease treating the cause of it will definitely reverse the ptosis symptoms.