Ophthalmology
Telephone: 0121 424 2000
Information for Patients
Ptosis Surgery – Information for Families Page 2 of 3
Version 1, May 2007
Information for Patients
Ptosis Surgery - Information for Families
Ptosis (or droopy eyelid) affects about 500 children in the UK each year. It is caused by a relative weakness of the muscle which lifts the eyelid(s) and is usually a problem of the eyelid clone. About 1 in 4 of the children we see have a family tendency to develop ptosis. Very occasionally it happens because of a more generalised muscle problem, and if we suspect that, then investigations will be necessary before going on to think about treatment.
Benefits of treatment
Ptosis may need correcting for a number of reasons. In very young children it can interfere with the proper development of vision and give rise to a lazy eye". Even when this doesn't happen it may be difficult for the child to see post the low lid and lashes and the ptosis needs correcting to allow the youngster to see well. Finally, of course, some children become very embarrassed by the comments of their friends and schoolmates.
The eye department staff will have discussed with you the need for an. operation and if you have decided to go ahead, this leaflet is designed to give you some information about the operation itself. There are 3 different approaches to correcting a ptosis, and the approach chosen will depend on how severe the ptosis is. You should check with the doctor which approach is to be used so that you can reed about the operation that will be performed on your child.
The procedure
The operations are carried out under General Anaesthetic and you will meet our anaesthetist before the operation. The children do not need stay in hospital afterwards‑, and can go home on the day of operation. Nonetheless it is worth bringing some night clothes with you since very occasionally a child does not feel well enough to go home the same day. The children need to be seen several times after the operation (in our Out‑Patient department) to ensure that the operation has worked as well as we want and also to ensure that your child is not running in to any problems after the operation. Whichever operation is chosen you or your child may feel it has not worked as well as you hoped. If that is the case, then the operation can be repeated if everyone agrees that it should be.
Levator muscle shortening
The most common operation we use is a shortening or tightening of the weak muscle. This involves making a cut through the skin of the eyelid in the skin crease behind the lashes. Through this cut we find the muscle, remove it from its attachments and shorten it by an amount decided upon at the pre‑operation check. The muscle is then stitched back in place and the eyelid cut is also stitched. The stitches used are dissolving stitches and do not usually need to be removed.
The operation itself has very few complications.
· Because we ore operating near the eyeball it might be possible to cut the eye during the procedure, but in fact we place a protecting shield between the eyeball and the lid during the cutting part of the operation.
· In the past people have described severe bruising occurring at the time of operation and pressing on the eye nerve to cause loss of vision. No complication of this type has occurred here in Birmingham
· Because of bruising in the muscle, it is common for the children to have a poor blink for a week or two after the operation and to sleep with their eye(s) slightly open. This will usually, but not always, settle over the first 2 to 4 weeks, but until it does you will need to put some ointment into the eye(s) to prevent excessive drying. Rarely, drying happens despite the ointment, and if it does we may have to undo the operation to let the lid down again to avoid ulcers and scarring.
· The swelling and bruising in the lid will usually disappear after 4 to 6weeks and the stitches fall out at around 6 to 8 weeks
Discharge Advice
We will confirm the arrangements for your following day clinical appointment before your leave the hospital. You will also be given eye drops to take home and directions how to use them. Start using them on the following morning as instructed.
Your child should not be in pain but the operated eye may feel slightly irritable. Give some Paracetamol or ask the ward nurses for some pain relief medication before you leave the ward: we will have prescribed some to be available for your child.
On your child’s first post-operative visit in the eye clinic we shall give you detailed instructions regarding the eye drops.
Swimming and particularly dusty environments (such as sand pits) should be avoided for at least 4 weeks after surgery. Try to discourage excessive rubbing of the operated eye.
Contact us
If your child is going to have an operation you may be asked to attend the hospital for a preoperative assessment. Please ask our staff any questions you may have about the treatment.
Alternatively, you can phone the main hospital switchboard on 0121 424 2000 and ask to speak to your Consultant’s secretary or ring 0121 424 0950 or 0121 424 3524 and ask to speak to Ms Jo Innes, senior Orthoptist.
Additional sources of Information
Contact NHS Direct Telephone: 0845 4647
Or visit them on the Internet http://nhsdirect.nhs.uk
Please use the space below to write down any questions you may want to ask:
Ptosis Surgery – Information for Families Page 2 of 3
Version 1, May 2007