Following problems on my right eye, it now looks smaller. I am curious to know what would fix my problem. I thinks it is called ptosis as it doesn't open as far as it did previously. Eyelid surgery? Thanks.
Eyelid Surgery for Ptosis of One Eye?
Doctor Answers (8)
Causes of ptosis
There are several causes of ptosis (the eye aperture appearing smaller)
1. Pseudoptosis - the appearance of ptosis when in fact that is not the case. This can happen when the eyeball is deeper in the socket (enophthalmos) or a patient has an eyeball alignment problem (hypertropia).
2. Muscle Looseness- when the muscle lifting the eyelid (levator) becomes loose
3. Neurological - certain nerves to lift the eyelid muscle can be impair and create ptosis (Third Nerve palsy/ Horner's syndrome)
4. Blood Disorders - Myasthenia Gravis - a blood disorder that causes eyelid droopiness that tends to get worse as the day goes on. It can be associated with myasthenia in the rest of the body which can have life threatening consequences
5. Reversible causes - ptosis can be caused by botox infiltrating into the eyelid muscle or even an eye allergy. These causes are all reversible and do not need surgery.
This is a tricky one
In general, eyelid ptosis results from anatomic or functional impairment of the ability of the muscles that elevate the eyelid margin to do their job with full excursion and power. It's like trying to raise a piano up to a window in a tall building with a rope and pulley - if the rope snaps or the rope is too slack, the piano won't make it up.
Oculoplastic specialists (ophthalmologists with extra expertise in surgery of the eyelids and orbits) are usually best suited to correcting this problem. They will often perform eyelid ptosis repairs under local anesthesia in awake patients to be able to control the position of the lid in repose.
Most plastic surgeons receive limited exposure to true ptosis repairs; the terms "ptosis" and "blepharoptosis" are often incorrectly used to describe "droopiness" of the lids which may be due to simple excess of skin, or due to a low-lying brow with fullness of the tissues below the eyebrow resting on the lids.
Hence, many plastic surgeons who say they treat "ptosis" of the lids are actually treating "dermatochalasis" or extra skin on the lid, while doing nothing for function of the lid itself.
If the problem is an inability to move the muscles in the lid with power and excursion, visit an oculoplastic surgeon or a plastic surgeon with SPECIFIC experience in ptosis repairs.
It is hard to know what is happening with your eye
It is helpful to know what sort of problems you had with your eye before your current condition. How long ago did your condiiton start? What procedure was performed on your eye? Did you go to an oculoplastic surgeon or opthalmologist for the original condition? If so, then it might be good to obtain a consultation with a real, board certified plastic surgeon by the American Board of Plastic Surgery--the only board recognized by the Amercan Board of Medical Specialties (the Gold Standard in Medical Boards).
If you do truly have ptosis, it can be corrected by several techniques. Plastic surgeons are the technical masters of soft tissue: skin, muscle, nerve, fascia, tendon, etc. and will have the appropriate training and skill to evaluate and correct this issue. Plastic surgeons deal with the entire gamut of reconstructive and cosmetic surgery of the face and will have the best experience and training in this area. There is an art and science to ptosis correction, of placing fine sutures on the fascia and muscle of the Levator (the eye muscle which allows opening of the lid) to match the other side. Find a plastic surgeon experienced with signficant eyelid surgery and you will likely increase your chance of a successful outcome.
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Several things can make the eye look smaller.
A number of factors affect the perception of eye size.
A droopy or ptotic upper eyelid will definitely make the eye look smaller.
However if the outer corner of the eyelids get stretched or the tendons that hold the lid at the outer corner become lax, the eye can look horizontally smaller.
Surgery that affects the orbital fat can allow the eye to sink into the bone socket that contains the eye. This results in the eye looking smaller. Retinal detachment repair where a scleral buckle was performed can produce this type of change.
Therefore a personal consultation with an ocuolplastic surgeon is invaluable in defining the problem and determining the best approach to addressing the issues. Oculoplastic surgeons are fully trained ophthalmologists who have done additional training in the field of eyelid and orbital surgery. General plastic surgeons do not receive nearly enough training in this subspeciality plastic surgeon area and with some exceptions, are not nearly as good a choice for a specialist to evaluate these concerns.
Ptosis repair in one eye.
This is a common occurrence. Whether it be after trauma, pregnancy, significant swelling in one eye, people can acquire ptosis later in life. It's important to have a thorough evaluation with an ophthalmologist before you consider surgery.
Drooping of one eyelid.
Eyelid asymmetry is not uncommon and has many causes. It is important to first determine the cause and then to see if the asymmetry is transient or medially treatable, or if it is permanent without surgical intervention. If the cause of a droopy eyelid is thought to require surgery, there are also many techniques to address the asymmetry. Typically an oculoplastic surgeon is best equipped to evaluate and treat ptosis.
I have attached a link to a video of a typical technique for surgical repair of ptosis.
Surgery to correct ptosis
Ptosis can occur on the eyelids and is usually worse in one eye than the other. Both eyes are usually fixed at the time of the ptosis repair because of the nerve reflexes that occur between both eyelids. Ptosis repair can be done as a standalone procedure or in combination with cosmetic eyelid surgery. Ptosis repair is a medical condition that can be covered under the patient’s insurance.
Consult with a specialist in ptosis
Ptosis is a complex problem. There are many causes, from congenital ptosis, to traumatic ptosis and senile ptosis. Correction of one side can affect the lid position on the opposite side and consulting with an expert in ptosis is your best bet ahead of time. Ptosis surgery sometimes needs postoperative adjustments so sutures are left in place just for that purpose. An oculoplastic surgeon or a plastic surgeon with an expertise in ptosis will be best able to help you.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.