Introduction

Oculoplastic surgery is a super specialty of plastic surgery and ophthalmic surgery. Oculoplastic surgery involves reconstruction and restoration of ocular structures and the orbital area. One of the most commonly carried out oculoplastic procedures is the corrective surgery for various problems of eyelids. “Droopy eyelids” is quite a common problem faced by many people and this occurs due to a condition known as ptosis. A large number of people choose to undergo a procedure known as blepharoplasty which is the name for the surgery that is carried out to correct droopy eyelids. The problems can be both in the upper and the lower eyelids. With the help blepharoplasty, excess fat and the skin tissues that may be causing droopiness of the eyelids may be removed. Ptosis causes the eyelids to be displaced downwards from their normal position.

Sagging of skin is quite an inevitable phenomenon associated with ageing. Medically, ptosis does not call for surgical intervention unless it is causing some problems with the vision of the patient. Ageing causes the eyelids to lose their elasticity and fall down and the eyebrows also begin to sag simultaneously. This causes the muscles of the eyelids to stretch and make them look really limp. A person’s youthful looks can be restored by the help of eyelid surgery which can correct the problem of droopiness of the eyelids and the sagging of the eyebrows. A highly qualified oculoplastic surgeon should only perform this surgery as the delicate components of the eyes are involved and it is a matter of a person’ vision as well as looks.

Ptosis, which calls for the need of an eyelid surgery, can be due to various reasons. Some of the most common types of ptosis are:-

  • Congenital ptosis: – This type of ptosis may be present in a child as a birth defect or may happen within a year of being born. Generally, congenital ptosis has not been observed to obstruct vision in children. However, if it is observed to become more severe with passage of time, it should be examined and if required surgical intervention should also be used. Both male and female babies can be affected. The real cause behind congenital ptosis is not known which makes it idiopathic in nature. Though the cause is unknown, some conditions have been known to cause congenital ptosis like blepharophimosis. Trauma at the time of birth and various other syndromes may be behind congenital ptosis. Most young children suffering from congenital ptosis do not require surgery however the caregivers are advised to keep an eye on any change that might take place in the state of ptosis. Ptosis may cause headaches and obstruction in the vision. Amblyopia may also be caused along with congenital ptosis. To assess whether or not a person’s vision is being affected by ptosis, the posture of the person’s head should be evaluated. In most cases of obstructed vision, the patient tends to keep their head tilted backwards and the chin higher than normal plane. If the vision is being obstructed due to ptosis, it may reduce permanently hence surgery is required to correct it. In babies ptosis may be accompanied by other facial irregularities. A paediatric ophthalmologist can best handle the cases of congenital ptosis.
  • Aponeurotic ptosis: – This ptosis is considered to be an acquired type of ptosis and it happens typically with ageing. It is also known as senile ptosis or involutional ptosis. The changes in the levator muscles can cause aponeurotic ptosis. In older people, ptosis definitely causes obstructed vision and visible difference in the symmetry of the eyelids. The level to which the vision is obstructed is tested by examining the vision of the patient with eyes in the normal condition and with the eyes taped up. Progressive pictures of the patient’s eyes can be a very helpful tool in assessing how far the condition has become worse. Aponeurotic ptosis is mostly corrected by surgery. The surgery involves tightening of the muscles of the eyelids which have become loose and to reconnect Aponeurosis to the tarsus. The surgery requires minimal invasion and the incisions may be as small as 4 mm. the patient is generally put under local anaesthesia. In patients, who are older in age, many a times a secondary corrective surgery is also required. This occurs due to the eye muscles being under corrected. Most patients are kept under observation till the time the edema has mellowed down to understand the real extent of the ptosis that has been corrected.

Older patients are restricted from excessive exposure to any type of harsh lights and are advised to refrain from any strenuous activities that may cause the incisions to rupture or to get infected.

Ptosis can be managed surgically by a skilled oculoplastic surgeon who can correct any associated deformities as well.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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