Ptosis (Droopy eyelids) surgery for adults and children
What is ptosis?
Ptosis is the drooping of the upper eyelid. It can occur in children as well as in adults.
Congenital ptosis occurs when there is a defect in the eyelid muscle causing the inability to lift up the eyelid entirely. This does not improve with time. It can be isolated or associated to other eye conditions like neurologic disorders, eye movement abnormalities, muscle diseases, lid tumours. The child may display abnormal head postures or tilts to try to use both eyes to see.
Treatment is crucial to allow the child to develop his or her vision normally in both eyes as well as it would be more aesthetically pleasing.
Amblyopia (lazy eye) is a major complication associated to ptosis as the eyelid blocks the vision, that particular eye is unable to develop normally. If the ptosis does not block the child’s vision, usually surgery is not required. However, the child should be reviewed regularly for amblyopia and other refractive errors. In severe cases of ptosis, the muscle would have to be tightened or reattached.
Adult ptosis may occur as the result of complications of neurological or muscular diseases involving the nerves or muscle of the eyelid. It could also be the result of ageing, trauma, after eye surgery. Severe ptosis can affect the peripheral vision, affecting performance of daily activities.
Treatment options available would be determined and offered to patients after the assessment of the ptosis and its causes by a registered Ophthalmologist. Surgical methods are usually the main treatment for ptosis, to reattach or strengthen the eyelid muscle.
There are a large number of Asians with an absence double eyelid crease. There are also many variations in the eyelid crease position.
The surgery for the creation or adjustment in double eyelids to improve the appearance of the eyes is called upper eyelid blepharoplasty.
Epiblepharon (in-turning of eyelashes)
Epiblepharon is the congenital abnormal horizontal fold of skin near the upper or lower eyelid margin resulting in the in-turning of eyelashes.
The in-turning of the eyelashes irritates the cornea and may result in symptoms like constant and frequent rubbing of eyes, redness, itching, tearing and sensitivity to light (photophobia). In severe cases, corneal scarring may result in vision loss due to the constant scratching of the eyelashes.
The treatment carried is determined on the severity of the condition and the extent of eyelashes rubbing on the cornea. Most children tend to outgrow it due to the maturation of their facial features.
In mild cases, artificial tears or ointments may alleviate symptoms.
Surgery might be offered to older children as it might not resolve on its own or in severe cases. The surgery involves the removal of a strip or excess skin and muscle from under the eyelid to allow the eyelashes to turn outwards. After the surgery, a faint line of the incision site may be seen, however, it will resolve after some time.
Excess skin or fatty tissue may be present on the upper and lower eyelids which is referred to as dermatochalasis
The surgery for the removal of eyebags is called blepharoplasty. Lower eyelid blepharoplasty is carried out more for cosmetic reasons. This is to reduce puffy eyebags and wrinkling of the skin.
The indication for upper eyelid blepharoplasty besides cosmetic reasons is for functional reasons. If there is significant amount of upper eyelid skin or fatty tissue, it may affect the peripheral vision which could affect daily activities.