What is Ptosis?
Ptosis is defined as the drooping of the upper eyelid. The two classifications of ptosis are congenital or acquired. Most of the patients who present with ptosis at The Mack Center have the acquired type. Ptosis can cause visual loss, particularly with obstruction of the peripheral vision. Patients may also notice difficulty with reading, as the ptosis is often worsened in down gaze. Ptosis will also decrease the overall amount of light that reaches the eye, and therefore can reduce visual acuity, particularly at nighttime.
What Kinds of Symptoms Would a Patient Have with Ptosis?
Patients with ptosis typically present to the Mack Center with complaints of loss of the superior visual field and peripheral vision. Patients note difficulty driving, reading, and interference with other daily activities. This condition can only affect one eyelid, though most times it will affect both upper eyelids. Ptosis is a progressive condition, and usually will progress slowly over many years.
What Causes Ptosis?
The two types of ptosis are congenital and acquired. By far the most common presentation at the Mack Center is acquired. This is secondary to involution or aging changes of the eyelids. The second cause of ptosis is congenital, which is due to problems with development of the muscle that raises the eyelid.
What is the Treatment for Ptosis?
The treatment for ptosis is surgery, with various surgical options. The surgery is performed on an outpatient basis. During the patient’s initial evaluation, ocular, medical, and surgical histories are obtained to identify appropriate candidates for ptosis repair. It is very important that the surgeon be aware of any history of dry eyes. The discussion of any coagulation problems or blood thinners will also be ascertained, as well as any history of thyroid eye disease, previous eyelid surgery, or eyelid trauma. Dr. Mack will then perform an examination to measure the position of the upper eyelid height and crease, and to measure the amount of functioning of the muscle that lifts the eyelid. This information will be used to determine the surgical procedure to correct the ptosis.
Less common types of ptosis can also be diagnosed through other tests which are also performed after the initial consultation with Dr. Mack. Commercial insurance carriers and Medicare may cover the surgical repair of ptosis if the impairment of the peripheral vision meets certain criteria. During the patient’s initial test, visual field testing will be obtained with the eyelids taped and untaped to determine the level of the patient’s functional impairment of the peripheral vision, and also the potential for visual improvement. External photographs will also be obtained, and the visual field and the external photos will then be sent to the commercial insurance carrier for predetermination of the surgery.
What Type of Anesthesia is used for Ptosis Surgical Correction?
The type of anesthesia used for ptosis surgical correction is IV sedation (MAC anesthesia), which is performed as an outpatient. MAC anesthesia is a procedure where the anesthesia team administers small increments of a sedative to allow the patient to be relaxed at which time the local anesthetic is administered for the patient’s comfort. Patients find this to be a very comfortable means to have surgery. Immediately following the surgery, ice packs will be placed on the patient’s eyelids. The patient will be discharged home with ice packs.
What is the Recovery Following Ptosis Repair?
Recovery following ptosis repair includes applying topical antibiotic steroid ointment for the first week following surgery. Sutures are removed at approximately 7-8 days following the surgery. The patient is asked to apply ice compresses to the bilateral upper eyelids following ptosis repair for the first 48 hours following surgery. Post-operative evaluations to monitor the patient’s progress will occur at the Mack Center.
What Can the Patient Expect Following Surgical Correction of Ptosis?
Following completion of the ptosis repair by Dr. Mack, the patient will have swelling and bruising of the upper eyelids. The patient is asked to avoid bending, lifting, and straining for the first week following surgery, and to have limited activities. The patient is also asked to apply ice packs and antibiotic steroid ointment. It is also recommended for the patient to take arnica and bromelain post-operatively to decrease the amount of bruising and swelling. At the one week post-op visit when the sutures are removed, the patient will still have evidence of bruising and swelling, but it should be much improved since the day after surgery. The patient should notice an improvement in their superior and peripheral vision, which will help with the patient’s function of daily activities, including driving and reading.
Will I Look Natural Following Ptosis Surgery?
The goal of the Mack Center is to have patients look natural with all of their procedures and surgeries. It is very important with ptosis surgery to position the upper eyelid so that the peripheral vision is improved, but also so that the patient can still close the eyes without any difficulties. This is particularly important for patients who have a prior history of dry eyes.
For more information on Tampa eyelid surgery, contact Dr. Mack’s office to schedule a consultation today.
Be sure and visit our Before & After gallery for this procedure.