PTOSIS SURGERY

Ptosis is a medical condition that describes the drooping of the upper eyelid. Ptosis might affect one or both of our eyes. Ptosis results in patients having a constant “sleepy” or “drowsy” look to their faces, giving the impression that they are always tired or disinterested. Patients suffering from moderately severe ptosis would also experience that their field of vision is partially blocked or obstructed due to the drooping eyelid.

Ptosis can be congenital or acquired, depending on when it develops.

• Congenital Ptosis - Present at birth, caused by improper development of the levator muscle, which lifts the eyelid.
• Acquired Ptosis - Develops in adults and can be further categorised:
  • Aponeurotic - The most common type, caused by age-related stretching or detachment of the levator aponeurosis.
  • Traumatic - Due to injury that damages the eyelid muscle or its supporting structures.
  • Neurogenic - Caused by nerve dysfunction affecting the muscles that lift the eyelid (e.g., Horner’s syndrome).
  • Myogenic - Results from muscle disease or disorders like myasthenia gravis.
  • Mechanical - Occurs when excessive weight (e.g., contact lens or chalazion) pulls the eyelid down.

Diagnosing ptosis typically involves an assessment of medical history and physical examination to assess the severity and cause of the eyelid droop. In addition, a comprehensive eye exam may be done, which may include tests like:

• The Marginal Reflex Distance (MRD) - This is a measurement used to assess the degree of eyelid drooping or ptosis. It measures the distance between the centre of the pupil and the upper eyelid margin.
• Levator Function Test - This measurement helps determine the severity of ptosis and guides the choice of surgical technique. During the test, the doctor holds the patient's eyebrow to prevent the frontalis muscle (the muscle that raises the eyebrows) from assisting in eyelid elevation. The patient then looks upward, and the distance the eyelid moves is measured.

Ptosis correction surgery is a procedure designed to lift a drooping eyelid. It is particularly recommended for adults and children whose vision is impaired by ptosis.

The aim of ptosis surgery would be to increase and permit a full view of vision by elevating the upper eyelid while aiming for a reasonable amount of symmetry for both eyes. This could be achieved by tightening the levator muscle and also by removing excess fat and tissue in the affected eyelids.

Ptosis correction surgery aims to address droopy eyelids by adjusting the muscles or tissues responsible for eyelid elevation. The specific surgical approach depends on the severity and underlying cause of ptosis.

• External Method
  This method is suitable when the levator muscle is still functional. The levator aponeurosis (the tendon-like extension of the levator muscle) is repositioned or tightened to restore its ability to lift the eyelid. This approach is usually done through an incision in the eyelid crease, and adjustments to eyelid height may be made during surgery to ensure optimal results.
• Internal Method
  Internal techniques are ideal for patients with mild ptosis and where minimal external scarring is preferred. This method is used to remove a small portion of Müller’s muscle or the tarsus (the cartilage of the eyelid) to improve eyelid elevation. It is done through an incision on the inside of the eyelid, leaving no visible external scars.
• Frontalis Suspension
  Typically reserved for severe congenital ptosis or cases where the levator muscle is not functioning well, this procedure involves connecting the eyelid to the frontalis muscle (the forehead muscle) using a sling. The sling can be made from the patient’s own tissue (such as fascia from the thigh), from a donor, or from synthetic materials. The frontalis muscle helps to lift the eyelid when the patient raises their eyebrows.

Pre-surgery
A comprehensive evaluation, including a measurement of the marginal reflex distance (MRD), will determine your candidacy for ptosis correction surgery. Suitable candidates typically have droopy eyelids that significantly impair their vision.

During Ptosis Surgery
The eyelid surgery is conducted under local anaesthesia and usually takes about 1 to 2 hours to complete. An incision will be made within or outside the eyelid crease to perform the surgery. Both eyelids can be operated on at the same time. After the desired correction is achieved, the incision is closed with sutures or surgical glue.

Post-surgery and Recovery
After the surgery, the eyelid that was operated on will be swollen. This typically subsides within 1 to 2 weeks. Medications will be prescribed to reduce swelling and minimise bruising. There may also be excess tearing causing temporary blurring of vision.

While the procedure is typically performed on an outpatient basis, it is recommended to rest for a few days after surgery. Regular follow-up appointments with your ptosis surgeon are essential to monitor your progress and address any potential complications.

While ptosis surgery is generally safe and effective, it is important to be aware of potential risks. Common temporary side effects include swelling, bruising, and temporary vision changes.

In rare cases, more serious complications may arise, such as overcorrection, under-correction, scarring, infection, or difficulty closing the eyelids. To minimise these risks, it is crucial to choose a qualified and experienced ptosis surgeon who can tailor the procedure to your specific needs.

• What is the average cost of ptosis surgery or droopy eyelid treatment in Singapore?

  The cost of ptosis surgery in Singapore varies depending on several factors, including the severity of the condition, the surgical technique required, and the surgeon's fees. Additional costs may include anaesthesia, facility fees, and medication.

  More complex procedures, such as those involving additional blepharoplasty or previous surgeries, may incur higher costs.

• Is ptosis surgery claimable under Medisave or medical insurance?

  Ptosis surgery in Singapore can be Medisave- and insurance-claimable if the severity of the condition meets the criteria set by the Ministry of Health (MOH).

• Is the result of droopy eyelid correction permanent?

  In most cases, the results of ptosis surgery are long-lasting. However, like any surgical procedure, there is a small chance of needing revision surgery.

  Patience is crucial during the initial recovery period, as swelling can temporarily affect the appearance of the eyelids. Once the swelling subsides, you can better assess the final outcome.

• What is the difference between ptosis correction and double eyelid surgery?

  While both procedures involve the eyelids, they serve different purposes. Ptosis correction is a functional procedure that lifts a drooping eyelid, which may improve vision. Double eyelid surgery, on the other hand, is primarily cosmetic, creating a crease to enhance the eye's appearance.

• Can ptosis be treated without surgery?

  Mild cases of ptosis may be managed with non-surgical methods like prescription eye drops or ptosis crutches. However, these non-surgical options can only provide temporary relief as they may not address the underlying cause of the eyelid droop. Surgery is often the most effective treatment for more severe cases and for long-lasting results.