Droopy Upper Eyelids – Ptosis

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There are many different reasons for a droopy upper eyelid. As an eyelid superspecialist Dr. Ahmad can help you understand the many different reasons that you may feel that your eyelids have drooped. If you remember when you were a baby your eyes were wide open. Why not, babies want to take in everything they see and experience! Why do our eyelids droop as we age?

Lets start out with a brief anatomy of the upper eyelid area. The upper eyelid complex is made up of the brow, the upper eyelid skin and the lifting muscles of the eyelid (the levator and mullers muscle). The muscles that lift up the upper eyelid are the brow muscles (frontalis) and the muscles in the eyelid itself.

So back to our initial question, why do uppper eyelids droop?

The droop can be just from the effects of aging. In our younger years our eyelids are tight and smooth. As we age skin stretches, fatty tissue can increase or herniate causing bulges in our eyelids that were not there before. Other factors include sun exposure, smoking history, family genetics, eye rubbing and previous eye sugeries. Extra skin on the upper eyelid is called dermatochalasis and can be treated with a blepharoplasty.

The droop can also be from weakening or stretching of the muscles that lift the upper eyelid complex which includes the brow muscle and the eyelid muscles. Drooping of the brow will require a brow lift or forehead lift. Drooping of the upper eyelid from a weak or stretched eyelid muscle is called ptosis (pronounced toe-sis).

Ptosis is usually because of stretching or thinning of the lifting muscle of the eyelid. Tightening of the lifting muscles will usually lift the eyelid. Some patients will have eyelid muscles that do not work and these patients will need a frontalis sling to lift the eyelid.

This can be repaired with a ptosis procedure.

Ptosis surgery is performed either through an external or internal approach. The external approach is through an incision made in the skin of the upper eyelid. This incision is placed in the crease of the upper eyelid and heals beautifully. The internal approach involves removal of tissue from the inside of the upper eyelid. Both approaches are excellent and Dr. Ahmad will give you direction on which procedure would be a better choice. Removal of excess skin is called a blepharoplasty and is not performed unless pre-approved by your insurance company or paid out of pocket by the individual. Ptosis surgery by itself will improve your peripheral vision, removal of skin will improve the cosmetic outcome.

Ptosis surgery can be performed in the office under a local anesthetic or in a surgery center or hospital under twilight sedation or general anesthesia. Risks of surgery include bleeding, infection, asymmetry, under-correction, over elevation, inability to close the eyes fully and eye irritation. Patients on aspirin, non-steroidals (ibuprofen), and other blood thinners like Plavix or Coumadin must discontinue these medications (after discussion with their medical doctor). Contact lens wear is usually stopped for several days after surgery, a back up pair of glasses is recommended after surgery.

After surgery your eyelids will be swollen for 7-10 days. Your eyes will be blurry and irritated for several days. The blurry vision may lost longer than several days for many reasons. Drops or ointments may blur the vision. After surgery the eyes may be drier because the eyelids are more open and the lids are not blinking naturally. This usually improves within the first several weeks. Patients who have persistent blurriness may need to use more lubricating drops until the vision improves. In some patients the lifting of the eyelid may change the shape of the cornea requiring a change in the patients glasses or contact lens prescription. Usually Dr. Ahmad does not recommend any change of prescription for 4 weeks after surgery.

Medical insurance will cover ptosis surgery if the droopy eyelid is affecting your peripheral vision. This will be decided by your insurance company after they receive your photos and visual field test. Removal of upper eyelid skin will not be covered by the majority of insurers and if desired will need to be paid by the patient prior to any procedure.

Dr. Ahmad has performed several thousand ptosis surgeries since 1998. He was the director of oculoplastic surgery at Loyola Medical Center from 2000-2006. Since 2006 he has been co-director of oculoplastic surgery at the Eye and Ear Infirmary at the University of Illinois. He has taught these procedures to residents and fellows for the last 12 years and will personally perform your procedure.

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