Link To Morrfields page on Ptosis

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Hi

I thought this link may be useful:

http://www.moorfields.org.uk/EyeHealth/Otherconditions/Ptosis

I have pasted 3 sections below. You will have to scroll down quite a bit to see it. (Couldn't work out how to remove the blank lines!)

Shireen

Ptosis

Ptosis is the medical name for a drooping of the upper lid, which can be present in one or both eyes. A low upper lid can interfere with vision and/or be a cosmetic problem. Ptosis can either be present at birth, or acquired later in life.

Treatment

Before a course of treatment is decided on, you will have a full eye examination and blood samples may be required to establish the correct diagnosis.

Treatment for ptosis is usually surgery. In adults, it is usually preferable to have the operation under a local anaesthetic, as the doctors have a more accurate assessment of the height of the lid at the time of surgery. The operation depends on the cause of the ptosis, but usually involves shortening the muscles and tendons which raise the lid.

Occasionally, the lid is raised by suspending it from the brow. This is either with a manufactured material or with tissue which is taken from the leg through a small skin incision above the knee (if tissue is taken from the leg, a firm dressing will be applied after the operation, which will usually be removed at the first outpatient appointment. There will be a stitch in the leg which is removed after about ten days. This may be done by you own GP). Surgery is often performed on both eyes in these cases, in order to achieve a better cosmetic result.

It is difficult to guarantee the success of the surgery. About 85% of patients are satisfactorily corrected with the first operation. The remaining 15% require a further procedure to correct such problems as the eyelid being too low, the eyelid being too high, the curve being irregular or the skin crease being defective.

There is also a danger of developing dry eyes or an infection after the surgery. It is important that any infection is treated quickly as this may affect the result of the surgery. When you leave the hospital, you will be given some antibiotic and lubricant drops to put in your eye, and some ointment for night time. It is essential that you use these, as these drops will help to prevent drying of the surface of the eye and the occurrence of an infection.

Causes of ptosis

Congenital ptosis is most commonly due to:

A defect in the development of the muscle which raises the eye lid. Although usually a cosmetic problem, vision on the affected side can be reduced in some cases. If one or both upper eye lids are low, a child may raise the eye brows or tilt his/her head backwards in order to see better. Surgery is recommended at an early age if vision is not developing normally. Marcus Gunn 'jaw-winking' ptosis is usually in one eye only and can be noticed at a very early age. The lid partially opens as the jaw opens due to an abnormal connection of the nerves. As a child becomes older it is less noticeable and rarely needs an operation, however, when surgery is needed, often it is necessary to operate on both eye lids. This will be explained and discussed with you by the doctor.

Ptosis can be acquired through:

A defect of the muscles and nerves of the eyelid which can occur due to simple ageing changes A weakness in the eyelid muscles, occurring in some rare muscle conditions A problem with the nerve which controls the muscle of the eyelid A mechanical defect caused by anything that increases the weight of the lid, such as a cyst or swelling

For Parents

Diagnosis

Children will undergo the same tests as adults, and will also often go to Orthoptic department where a series of painless tests are carried on the muscles of the eye.

Treatment

Surgery is usually the treatment for ptosis, but will not be performed on your child until he/she is 3 to 4 years old, as it is necessary to gain his/her co-operation before and after the operation. The operation itself is carried out under general anaesthetic.

A photograph will be taken prior to the operation to compare the position of the leye lid before and after surgery. Your child will have a pad on the operated eye after the operation, and this will be explained to him/her beforehand. The pad will stay on until the following morning, when he/she will normally be discharged. However, it will be 2-3 weeks for the swelling in the lid to go down.

Aftercare

Before returning home, the nurse will clean around the eye and instil drops. Usually drops and ointment will be prescribed for use at home, and the nursing staff will show you how and when to use them. Before your child is discharged, the doctor will see him/her and make sure that everything has gone well and he/she is fit for discharge. An appointment will be made for 5-7 days after discharge, with a second appointment 2 weeks later when the swelling in the lid should have gone down and a more accurate assessment of the result of the surgery can be made.

Once home, your child will be asked not to bath for 2-10 days, but may wash or shower. Swimming is not allowed for at least 2 weeks, and longer if the eye is still red. If your child plays football, he/she must not 'head' the ball for 6 months if he/she has had an operation joining the lid to the eyebrow.