Ptosis surgery (drooping eyelid)

We speak of ptosis when the upper eyelid is too low and hangs down over the eye. The malposition can occur on one or both sides, be present from birth or occur due to age. Depending on the cause and severity, we may recommend surgical correction. Depending on the type of ptosis, there are different surgical methods. In most cases, the eyelid lifting muscle is shortened and, if necessary, the existing excess skin is also removed. This allows us to open the eye again, which improves both the visual field and the aesthetics.

What is ptosis?

Ptosis is a congenital or age-related malposition of the upper eyelids in which the eyelid cannot be raised sufficiently. This causes the eyelid to permanently hang down over the eye. Ptosis can significantly limit vision, especially if the eyelid has dropped to above the pupil. Depending on the cause, ptosis occurs on both sides of the eye, more rarely on one side. Both adults and children can be affected.

Ptosis should not be confused with dermatochalachis. This is a slackening of the eyelids, usually due to age. While dermatochalachasis is purely a sagging of the skin, in ptosis the edge of the upper eyelid is too deep. Excess skin can also occur and is then removed during the ptosis operation. 

What can cause ptosis?

If ptosis has been present since birth, it is usually due to a maldevelopment of the eyelid elevator muscle. Certain muscle diseases can also cause a drooping eyelid. Furthermore, ptosis can occur if there is damage to the responsible nerves. In this case, ptosis is often accompanied by a paralysed squint because the affected nerves are also responsible for other eye muscles.

However, ptosis is often a symptom of old age that occurs more frequently in contact lens wearers. With increasing age, there is a certain slackening of the tendons and muscles. Occasionally, a drooping eyelid also occurs after eye surgery, injuries or as a result of illness. If symptoms appear suddenly, a stroke must also be considered. Therefore, before we decide on a ptosis operation, comprehensive examinations are carried out to exclude disease-related causes.

How can ptosis be treated?

The only way to treat a too deep-set upper eyelid is surgical correction. Ptosis surgery corrects the drooping eyelid by folding or shortening the eyelid lifting muscle. If there is additional excess skin on the upper eyelid, this is also removed during the ptosis operation to achieve a functionally and aesthetically optimal result. 

In children, ptosis can be accompanied by other eye diseases, e.g. amblyopia (defective vision). In this case, the ptosis operation is only one part of a longer-term treatment concept. Regular ophthalmological check-ups are indispensable in this case.

What is the procedure for a ptosis operation?

If your ophthalmologist has advised you to have a ptosis operation, a comprehensive preliminary examination is necessary first. In addition to a thorough examination of the eyes, imaging procedures or neurological tests may also be used. 

Certain medications (e.g. blood thinners) must be temporarily discontinued before the ptosis operation. If you are dependent on taking medication, you should inform the attending physician about this. He will then discuss the further procedure with you. As a rule, the ptosis operation is performed under local anaesthesia with sedation. The anaesthetist administers sedative medication and painkillers via the arm vein. Then the tissue in the upper eyelid area is locally anaesthetised. The exact procedure of the operation depends on the cause and severity of the eyelid lifting weakness. As a rule, the surgeon makes an incision in the crease of the eyelid and then folds or shortens the eyelid lifting muscle. 

A bilateral ptosis operation takes about 90 minutes. Your ophthalmologist will decide whether the operation is performed on an outpatient or inpatient basis, depending on your findings.

What do I have to keep in mind after the ptosis operation?

After the ptosis operation you should take it easy on yourself, especially during the first few days. Initial bruising and swelling can be counteracted by careful cooling. The eye area should be touched as little as possible during the first few days. Any kind of pressure or traction on the upper eyelids should also be avoided. Most patients are able to return to work within 1 week after eyelid correction.

When planning your daily routine, you should bear in mind that swelling may still be visible during the first 14 days after the ptosis operation. You should take a break from sports, sauna and swimming pool visits for 1 to 3 weeks in consultation with your doctor.

What are the risks of ptosis surgery?

As with any operation, there is always a certain risk of complications with ptosis surgery. For example, infections, secondary bleeding, wound healing disorders and injuries to the eye structures can never be completely ruled out.

Above all, it is important that you consult an experienced and appropriately qualified surgeon. In our eye clinic, a high level of treatment safety is guaranteed, as all procedures are performed by highly experienced specialists.

Occasionally, the eyelids may not appear absolutely symmetrical after the ptosis operation. In this case, a follow-up operation may be necessary. However, this is done at the earliest after about 6 months, when the healing phase is almost complete.

Can the drooping eyelid recur?

After surgical correction, recurrence of ptosis is rare but not impossible. Due to the natural ageing process, a certain amount of tissue slackening occurs again over the years. A follow-up operation may therefore be necessary even many years after the initial operation.