Upper Lid Ptosis Surgery in Jaipur
Ptosis is when the upper eyelid droops over the eye. In the normal position, the upper eyelid rests at the upper limbus in children and 1.5 to 2 mm below the upper limbus in adults. The lower eyelid is usually positioned at or 1 mm above the lower limbus.
The eyelid may droop just a little or so much that it covers the pupil (the black dot at the center of the eye). Ptosis can be mild-moderate or severe, depending on how much the eyelid droops and cover the pupil. This can lead to partial or complete loss of vision. Ptosis can occur in children (also known as congenital) or can occur in adults as person ages.
Children who are born with ptosis; this condition is known as congenital ptosis. The reason for congenital ptosis is the abnormality in the muscle that lifts the eyelid (known as levator muscles).
Ptosis In Children
The drooping eyelid is the major sign of ptosis or if there is an asymmetry between the two (upper eyelid being at a different level than the other) or there can be bilateral ptosis, which involves both the eyelids. A child with ptosis can have an issue in vision due to eyelid covering the pupil (the black hole or spot in the center of the eye), or they may have to keep their head back, chin lifted, or an eyebrow raised to see better. Over time these habits forming movements can cause head and neck posture problems.
Ptosis in children can lead to secondary problems like if the eyelid droops too much, it can block the vision, and amblyopia can develop (also known as lazy eye) that can lead to non-use brain atrophy of vision in the affected eye. A child can also develop astigmatism leading to blurry vision or can develop strabismus (cross-eyes).
Ptosis In Adults/Age-Related Ptosis
This is also known as involutional ptosis resulting from the age-related separation of levator muscle away from the eyelid. It can also occur after an eye injury or sometimes can happen after eye surgery.
Ptosis Treatment
Ptosis treatment depends on the degree of ptosis and the remaining levator function. The present procedure/surgery varies:
- Levator resection: Levator–Müller’s muscle resection (if levator function is good).
- Levator advancement: (if levator function is good).
- Sling surgery: Silicon sling or fascia lata sling (if levator function is poor).
Note
Special Conditions
Jaw Winking Phenomenon
Ptosis with synkinetic eyelid movement is also known as the Marcus Gunn Jaw Winking Phenomenon. Acquired causes are aberrant third nerve regeneration, aberrant regeneration of the seventh nerve with eyelid closure on smiling (Inverted Marcus Gunn phenomenon), gustatory lid retraction with Horner syndrome, and other anomalous cranial nerve connections to facial eyelid muscles, such as the spinal accessory eleventh nerve.
FAQs About Upper Lid Ptosis Surgery in Jaipur
What needs to be evaluated before surgery?
- Strength of the eyelid muscle (remaining levator function).
- Degree of ptosis.
- Bell’s phenomenon (upturning of the eye on the closing of the eyelid).
- Strabismus (cross-eye).
- Any synkinesis (movement of the eyelid along with the movement of the jaw).
- Involvement is unilateral or bilateral.
How is the procedure performed?
In milder to moderate degree of ptosis with good levator muscle function, either levator resection or levator advancement procedure is carried out. The procedure is done under local anaesthesia or IV sedation. The incision is made over the proposed lid crease 10 mm in females and around 8 mm in males. The levator muscle is dissected over the tarsal plate and resected and or advanced over the plate and sutured in the place where the desired elevation is required. The lid crease is made then by suturing the levator to the skin or levator to the tarsal plate. The sutures placed are absorbable. There is an immediate improvement in the lid elevation.
In a severe degree of ptosis with poor levator muscle function, the frontalis sling operation is carried out, in which the sling made of either the facia-lata harvested from owns body(from the thigh) or silicon rod (implant material) is placed in a specific manner to the tarsal plate and is attached to the frontalis muscle. The patient gets a good elevation on the table and can see the improvement immediately.
This patient underwent surgery for #ptosis that is for droopy upper eyelids. He has bilateral ptosis eyelids (both eyes affected). #ptosiscorrection correction had been done in both eyes, starting with the left eye then on the right. These are the initial surgical results. Although the surgery can be performed on both eyes simultaneously, that is in a single session. During the procedure, no external or prosthetic materials were used.
In this patient, there was unilateral congenital #ptosis present. The levator function was good, and the degree of ptosis was mild. The levator advancement procedure is performed in this particular patient to improve the levator muscle function. The procedure was technically challenging and required fine skills. Moreover, the follow-up results are obvious with lid crease creation and #ptosiscorrection.
1 Hour.
Local Anaesthesia.
Not required.
Not required.
Swelling reduces in 24 to 48 hours.
3 months.
No precaution is needed.
No precaution is needed.
