Overview

Ptosis is the drooping of the upper eyelid. It can happen in one or both eyes.

Ptosis can affect the upper field of your vision. It can also cause eye strain, eyebrow ache or cosmetic concerns.

Causes of ptosis

Ptosis can be present at birth. This is known as congenital ptosis, and is usually due to a defect in the upper eyelid muscle.

More commonly it appears later in life, as an acquired ptosis.

This can be caused by:

• wearing contact lenses for a long time
• trauma
• eye surgery

These can all cause stretching of the upper eyelid tendon. Sometimes this stretching is just caused by age-related changes in the eyelid.

There are a few other rare causes of ptosis which include conditions that can weaken the eyelid muscles, such as myasthenia gravis or myotonic dystrophy. Other conditions cause paralysis of the nerves supplying the eyelid. 

Surgery

Ptosis surgery is a treatment that can be used to lift one, or both of your upper eyelids.  The surgery is usually done under local anaesthetic, although sometimes some sedation can be given during the procedure to help you to relax. If you think you will require sedation, please discuss this in the clinic, as it will need to be planned.

Benefits of ptosis surgery

Ptosis surgery can improve your field of view and brighten your vision. It can also relieve eye strain and brow-ache or headache if these are caused by the eyelid droop. It should improve the symmetry of your eyes.

Risks of ptosis surgery

Ptosis surgery is generally successful, with 8 out of 10 eyelids being in a good position after surgery.

As with any surgery, there are some risks associated with it. These include:

Bruising and swelling

This is common and may remain for a few weeks after surgery.

Infection

An infection in the wound is possible. This might require antibiotics.

Restricted eyelid movement

As the eye is being opened up more, it might be harder to close it after surgery.

‘Gritty’ eyes

Your eye might feel dry and gritty for a few months, and you might have to use artificial tear supplements.

Asymmetry of the eyelids (they might not ‘match’)

The surgery is not absolutely precise due to the number of factors that can affect the final lid height. Under-correction or over-correction is possible which might need re-evaluation and more procedures.

Vision disturbance

Bleeding into deep tissue can lead to disturbance of vision and could lead to loss of vision in severe cases. This is extremely rare, and you should report any loss of vision to the hospital immediately.

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

Read more about our consent process

Remember that you might need to bring your reading glasses with you to help you read the consent form. If your sight is poor, you can ask the doctor or a relative to read it to you and check it before you sign.

Preparing for ptosis surgery

You will be assessed in the clinic and can discuss the surgery in detail with your eye surgeon. You will have a pre-operative assessment with a nurse where more information will be provided.

Changes to your medicines

You might need to make some changes to your medicine before surgery.

You should let us know if you:

• are taking any blood-thinners, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for example warfarin or rivaroxaban). As you might need to stop them temporarily before your surgery
• have diabetes, as you might need to change the dose (amount) of your diabetes medicines
• are taking any regular medicines (including anything you buy from a pharmacy or shop, and any herbal or homeopathic medicines)
• have any allergies to any medicines

More information on stopping medicines will be given to you at your pre-assessment appointment.

Surgery under local anaesthetic

If you are having the surgery under local anaesthetic, you can eat as normal before the treatment, but you should only have a light meal.

On the day of surgery

Please wear comfortable, loose-fitting clothing on the day of surgery.

You might need to arrange a responsible adult to help you on your way home. They might also need to stay with you for at least 1 day after the treatment.

During surgery

You will lie on a couch in the operating room and anaesthetic drops will be put in your eyes. Your face will be cleaned with antiseptic solution, and a sterile cloth will be placed around your face.

The surgeon will use a pen to mark out the skin to be removed. Local anaesthetic is then gently injected under the eyelid skin, which causes a sharp, stinging sensation for few seconds.

The surgery takes about 45 minutes for each eye. You might feel some light tugging on your eyelid during the surgery, and you might be asked to look up and down.

At the end of the surgery, the wounds are closed with stitches, ointment is applied, and a pressure dressing is placed over the eyelids. If you have both eyes done, one of the eye pads will be removed after about 1 hour.

Pain

Anaesthetic is injected under the eyelid skin, which causes a sharp and stinging sensation for few seconds. After this, you should not feel any pain, although you might be aware of some pulling sensations.

Your eye might be slightly painful for 24 to 48 hours after the surgery, and you can take paracetamol regularly to help with this. Always follow the instructions on the packet.

Leaving hospital

You will be given some antibiotic ointment or drops, and some lubricating eye drops. This is to minimise the risk of infection, and reduce dryness in the eye. It is important to wash your hands before using these, to reduce the chance of any wound infections.

Your vision might be blurred for few days after surgery, and you might not be able to wear contact lenses.

Getting back to your routine

You might want to take few days off work, depending on your individual circumstances.

You should not resume any strenuous activity, including swimming, for 2 weeks after surgery.

It is best that someone stays with you to help you for at least 1 day after the treatment. 

For 24 hours after your surgery:

Follow-up appointments

Before you leave hospital, you will be given an appointment for the outpatient clinic for 1 to 2 weeks after your surgery. It will take place in the eye department at St Thomas’ Hospital.