1.5mm ptosis in right eye. Oculoplastic surgeon said I shouldn't get surgery. What should I do? (Photo)

Question

I visited an oculoplastic surgeon today who told me I had ptosis in my right eye. He was unable to determine if it was congenital ptosis. I wanted to have surgery to repair my ptosis, but he said it was too risky and a complicated surgery. My ptosis is causing me significant distress and I need this to be corrected. What should I do now? Should I find a different occullplastic surgeon? If my problem treatable? Please help! Thank you!

Kenneth D. Steinsapir, MD · Answer

I routinely operate on small amounts of upper eyelid ptosis with very good results. Humans need a degree of accuracy in their upper eyelid surgery that is very frustrating for most ptosis surgeons to provide. The outcome of ptosis surgery is discerned by hyperacuity or vernier accuracy.  This is about 10 times more accurate than the acuity measured by the eye doctor.  For this reason, most ptosis surgeons tell their patients that ptosis surgery is only accurate plus or minus 1 mm.  For most patients I operate on, that will simply not be accurate enough.  Many surgeons like the posterior approach because it is simple and predictable.  However, in my opinion, the results are mediocre.  I much prefer the anterior approach. This means that the effects of ptosis surgery can be monitored during surgery.  While no surgery is perfect, this often results in outcome that are superior to what can be achieved with posterior approach ptosis surgery.

Joseph Walrath, MD · Answer

Hi,
I am not sure why you should not get surgery if you want it.  Contraindication to surgery in your case might be extreme dry eye, but it doesn't seem like that is an issue, from what I can gather.
I don't see much by way of significant risk or complications.  The greatest risks are:
1. Financial.  You would be charged for surgery.
2. Reoperation.  Internal ptosis repair revision rate is 5%.  External ptosis repair revision rate is 10%.  It is not possible to say which technique is best for your situation, but quite likely it is the internal repair.  This can be done in the office and takes about fifteen minutes.
Best,
JDW

John R. Burroughs, MD · Answer

Yes, this can be repaired, but it is likely cosmetic and not to be covered under insurance.  There can be reasons not to have it repaired to include: cosmetically acceptable to you; lack of sufficient finances; risk that it would not work or be worse; risk the other eye could droop following repair of your droopy side (Herring's Law); other surgical complication risks; unrealistic expectations; and other concurrent life stressors.  I'm not sure why the surgeon said they wouldn't recommend it, but you can get another opinion.  Many of us oculoplastic surgeons will do such small ptosis surgeries on suitable candidates that have realistic expectations and realize there can be no guarantee that it will work, but in experienced hands about 90%+ of the time get a result within 1 mm of the other side.  Ptosis surgeries can be quite unpredictable, and I counsel my patients that there is about 10% risk of needing to do a revision surgery to get the result desired, and I have done thousands of ptosis surgeries.  I was trained by one of the busiest and most experienced ptosis surgeons of all time, and once saw a thyroid patient with ptosis require 5 surgeries to get the result wished.  This is not very common, but some variables (prior surgery, thyroid eyelid disease etc.) make ptosis surgery less predictable.  There are too many other factors to discuss here, but I have provided a link I think you will find helpful.  If you responded well to a phenylephrine test then I would suggest an internal (inside the eyelid) ptosis repair, which usually has a fast healing time with no external scar.  Best regards.

1.5mm ptosis in right eye. Oculoplastic surgeon said I shouldn't get surgery. What should I do? (Photo)

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