Drooping eyelid

Acquired ptosis usually occurs bilaterally in adults and can have various causes. The attachment point of the levator muscle on the upper eyelid slips upward over time: the muscle functions well, but it can no longer lift the upper eyelid to the correct height. In severe cases, the upper eyelid may partially or completely cover the pupil. Typically, the eye appears "deeply sunken" because the base of the levator muscle has moved up so far.

Ptosis can restrict the visual field and also damage the cervical spine because patients try to compensate for the restricted visual field by constantly lifting the chin.

The success of the surgery also depends on how good the remaining strength of the eyelid elevator muscle is. Different approaches can be used, from Fasanella-Servat surgery to levator resections and levator reinsertions.

Acquired ptosis must be differentiated from congenital ptosis. In congenital ptosis, the function of the levator muscle is usually much worse and therefore surgery must be performed differently.

• An age-related slackening of the connective tissue.
• The wearing of hard contact lenses. These stretch the levator muscle. In about 10% of all wearers of hard contact lenses, slowly progressive ptosis occurs after about 10 years.
• Previous eye surgery in which an eyelid retractor was used.
• Previous severe inflammation or accidents resulting in massive swelling of the upper eyelid.
• In very rare cases, ptosis is caused by a yet undiscovered muscle disease or neurological condition (myotonic dystrophy, myasthenia).

Here, the levator muscle is attached to its original attachment in the upper eyelid. This operation is performed under local anesthesia, because it is important that we can check the height of the upper eyelid several times during the operation.

After a skin and muscle incision, the levator muscle is exposed and reattached to the connective tissue plate of the upper eyelid (tarsus). We then check the position of the upper eyelid and adjust the height until a satisfactory result is achieved. If there is excess skin on the upper eyelid, this can also be removed during the operation. If this is not done and the upper eyelid is again (correctly) higher after the operation, the excess skin will otherwise be even more pronounced.

Here, the connective tissue plate of the upper eyelid is shortened from the inside. This operation takes about 30 minutes and is performed under general anesthesia. We perform a Fasanella-Servat operation if the extent of ptosis is only slight.

In 15% of cases it can happen that after the operation a good result is achieved for the single eye, but there is a certain asymmetry between the lid opening of both eyes. It is not always possible to avoid this, because the wound healing can additionally change the eyelid height.

But even in healthy eyes, perfect symmetry of both upper eyelids is rare. A certain slight lateral difference after surgery should be tolerated.

Patience, patience and patience again: the final eyelid height is not stable until about 6 months after surgery. Until then, there may be under- or overcorrection. Therefore, it is especially important to exercise patience during this operation. If after 6 months there is still a significant difference (> 2mm), then we will suggest a re-operation if necessary.