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Ptosis: Upper Eyelid Drooping
Ptosis (“toe-sis”) is apparent at birth (congenital) or develops with age (involutional).
Congenital ptosis by itself rarely leads to poor vision, since children tilt their head backward in order to see. However, children should be examined by an ophthalmologist because they can have other associated eye problems. Surgery to correct ptosis is commonly recommended in the preschool years to eliminate the head tilt, enlarge the field of vision, and improve appearance. The type of surgery varies, depending upon the amount of droopiness.
Involutional ptosis develops with aging. It may worsen after other types of eye surgery or eyelid swelling. Ptosis may limit the field of vision and produce an unbalanced appearance. Surgical correction involves shortening of the muscle which opens the eyelid.
Excess Eyelid Skin
Over time, many people develop excess eyelid skin. Eyelid skin is the thinnest skin of the body, making it most susceptible to stretching.
In the upper eyelid, this stretched skin may limit the field of vision, and may produce a sensation of heaviness and a tired appearance. In the lower eyelid, “bags” form.
The excess skin in the upper eyelids can be removed surgically to improve the field of vision and other symptoms. Removal of the excess skin in either the upper or lower eyelids may provide a cosmetic improvement, if any fatty tissue is present, it may be removed at the same time.
Ectropion: Outward Turning of the Lower Eyelid
Stretching of the lower eyelid with age allows the eyelid to droop downward and turn outward. Eyelid burns or skin disease may also cause ectropion. Ectropion can cause dryness of the eyes, excessive tearing, redness, and a sensitivity to light and wind. Surgery may restore the normal position of the eyelid, improving these symptoms.
Entropion: Inward Turning of the Lower Eyelid
Entropion also occurs most commonly as a result of aging. Infection and scarring inside the eyelid are other causes of entropion. When the eyelid turns inward, the eyelashes rub against the eye creating a red, irritated eye sensitive to light and wind. If entropion is not treated, an eyelid ulcer may form. With surgery, the eyelid can be turned outward to it’s normal position, protecting the eye and improving these symptoms.
Eyelid Plastic Surgery
Eyelid plastic surgery is usually performed on an outpatient basis using local anesthesia. If you are taking aspirin or aspirin-containing drugs, blood thinners, or have a bleeding problem, you should tell your ophthalmologist.
This surgery is generally safe, however, as with any surgery, there are certain risks. The ophthalmic surgeon attempts to create a balanced result, but due to differences in healing between the eyes, there may be some asymmetry following surgery. A “black eye” is common, but will resolve quickly. The eye may feel dry after surgery because complete eyelid closure is more difficult. This irritation generally disappears as the surgery heals.
Serious complications are rare. The risk of losing vision is estimated to be less than one in 5000 surgeries. Scarring and infection occur infrequently.
Your ophthalmologist will perform an eye examination and make recommendations. Photographs and visual field testing are often required by insurance companies before surgery.
Eyelid plastic surgery procedures can be done safely in an outpatient setting by your ophthalmologist. The improvement in vision, comfort, and appearance can be very gratifying.