Ptosis operation or double eyelid operation?
I've had lazy eye (or ptosis) since I was young. I’ve always had double vision whenever
I wanted to concentrate on something, but it happens only once in a while. Should I
have an operation done? And what operation should I do? I'm 17 going on 18 so I'm becoming
a little more self conscious about myself.
Thank you for your question!
You’re 17 years old and going on to 18 and you submitted a single photo that demonstrates
the presence of ptosis involving the right upper eyelid and that you state that you had
this “lazy eye” since you were a child. You mentioned about double vision that occurs
when you concentrate and so we can talk about that as well. And you are asking whether or
not you have this addressed.
Well, as a specialist in eyelid surgery and an oculoplastic surgeon, eyelid ptosis is
a very common issue that we deal with. And when it comes to congenital ptosis, prior
to the age of 6, it’s important to make a decision of correction based on visual development.
However, after age 6, it becomes about the aesthetics and symmetry. Naturally, it should
also involve the functionality but I think that you can probably get a sense of whether
or not lifting the eye will be in any way interfering with your visual function simply
by manually lifting up your right upper eyelid. That being said, I think that you should have
a full ophthalmic evaluation and see what the best corrected vision in both eyes are
and see what the impact would be in lifting the right upper eyelid.
A lot of times has a condition such as amblyopia where one eye, the visual function doesn’t
develop much because of partial occlusion of the eye and lack of stimulation before
the age of 6, then it is usually not necessarily a problem because the suppressed vision in
that eye and it’s more about the aesthetics. But assuming you can tolerate the eyelid being
open, I think the choice of when to do surgery is a personal choice. If the drooping eyelid
bothers you enough, then having a procedure makes a sense. I always tell patients, observe
I should say people who have had congenital ptosis is that they’ll have a minimum of
about 3 operations in their lifetime. One will be when they’re very young for functional
reasons. One will be teens to twenties for cosmetic reasons and then, if the eyelid stays
open and it depends on the type of ptosis you have then one on the later decades because
everything starts to droop and the eyelid needs to be lifted again.
So, in your situation, I will describe what we would do for a patient like yourself. First
of all you have to see what kind of ptosis surgery is appropriate for you. There’s
ptosis surgery that’s based on good muscle function and then there’s surgery based
on poor muscle function. So, depending on that, we would figure out whether to shorten
the levator muscle, the muscle that lifts the eyelid or whether to do something called
a frontalis sling where the eyelid is actually attached through some kind of a connection
between the eyelid margin and the eyebrow so that when you raise the eyebrow, the eyelid
opens.
So that being said, another thing that we do in our practice for patients who are not
children but are old enough to cooperate is we actually do the ptosis surgery with local
anesthesia with LITE™ IV sedation and we have the patient be awake for the adjustment
of the eyelid. This is a specialized area and a tricky thing about ptosis surgery is
achieving the optimal shape, contour and height so that there’s maximal symmetry. You know
if you’re bothered by the asymmetry of the eyelid drooping, well you don’t want the
eyelid too low or too high after the surgery. We try to balance this by doing this procedure
by having our patients sit up during the surgery. They never feel any pain but at least we’re
able to try to judge whether or not the eyelid would be stable and looks good with gravity
factored in. Ptosis surgery can turn out to be very gratifying for the patients and make
a tremendous difference in their appearance and their confidence. It so it seems based
on the limited amount words in your question is that you do have a concern that maybe will
have an impact on your confidence. And so, getting some opinions from professionals and
specialists such as oculoplastic surgeons or oculofacial plastic surgeons will give
you an idea of what your options are.
So I hope that was helpful, I wish you the best of luck and thank you for your question!