Ptosis
A drooping eyelid is known as blepharoptosis or ptosis. The upper eyelid tends to fall to a position that is lower than normal. In very severe cases, the drooping upper eyelid can cover a part or the entire pupil which causes interference in vision, resulting in amblyopia.
Ptosis can affect one or both eyes. Ptosis may be present at birth or it may develop later in life. If Ptosis is present at birth or within the first year of life, the condition is known as Congenital Ptosis. Most of the time, the condition is isolated early and hence does not affect vision. Any ptosis that develops over a period of days or weeks can signal a serious problem requiring further neurological and physical evaluation.
Procedure
Congenital ptosis has physical, functional and psychological consequences. The method of repair depends on treatment goals, the underlying diagnosis, and the degree of levator function. Although the primary reason for the repair is functional, the surgeon has an opportunity through this procedure to produce symmetry in lid height, contour and eyelid crease.
Correction of Congenital Ptosis through surgery can done at any age depending on the severity of the disease. An early intervention may be required if significant amblyopia or ocular torticollis is present. Toddlers and Infants may experience delayed mobility because of extreme chin-up head posture. If intervention is not urgent, surgery is often delayed until the child has reached 3-4 years.
Levator Muscle Resection
In this procedure a lid-crease incision is made which helps shorten the levator-aponeurosis complex. The skin incision is made so as that it is hidden either in the existing lid fold or in a new lid fold which is created to match the contralateral eyelid.
Frontalis Suspension Procedure
In this procedure, the patient's lid elevation is done through brow elevation. Frontalis suspension procedures produce lagophthalmos in most cases. Some surgeons prefer to perform a bilateral suspension procedure for severe unilateral congenital ptosis to obtain symmetry.
Fasanella-Servat Procedure
In this procedure, a block of tissue is removed from the underside of the lid which helps the upper lid to become elevated. This procedure is usually not done for cases of congenital ptosis.
Muller Muscle–Conjunctival Resection
If the eyelid is found to have a good response to phenylephrine, the Muller Muscle-Conjunctival Resection procedure is done. The conjunctiva and the Müller muscle are marked off, clamped and sutured. The tissues are resected and the conjunctival layer is then closed.
This procedure is not commonly performed for cases of congenital ptosis.
Associated Risks
Complications associated with the procedure include the following:
Recovery
Patients are initially monitored every 2-4 weeks for signs of exposure keratopathy, infection, granuloma formation, and overcorrection and undercorrection. External photographic documentation can be helpful in monitoring patients.
Following the surgery, visual acuity, head posture, and refractive error should be carefully monitored. Any residual amblyopia should be treated aggressively.
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