Internal ptosis repair - right eye
Doctor Answers 8
Internal ptosis repair
The drop test is useful but not exact. The answer really depends on the examination, how severe the ptosis, the muscle function, etc. The technique for ptosis repair depends on above factors and surgeon's preference.
The strength of the levator muscle which is the muscle in question is adeequate (determined by physical examination) levator shortening done through the eyelid crease can be effective.
I routinely do an external incision ptosis repair by tightening the levator muscle. This should work for you.
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Internal vs. External ptosis repair
Internal ptosis repair involves shortening Muller's muscle, a small muscle on the under side the eyelid, which raises the lid about 2 millimeters. Exnternal ptosis repair involves making a skin incision in the eyelid crease, isolating the levator muscle, which does most of the work in opening the eyelid, and shortening or advancing the muscle forward so it will fully open the eye. Your oculoplastic surgeon will determine which procedure is best given your examination. Both are effective for ptosis repair.
Internal ptosis repair
Some studies have shown that you can still get a lift of the lid if you didn't respond to the drop. We just like to see it lift with the drop since we know in those cases that it should work well. YOur option is to do an external approach through the lid crease. This will produce a small but usually undetectable scar.
I routinely use anterior levator ptosis repair.
Do not let your surgeon do an internal ptosis surgery if you do not respond to the drop test. It is a waste of time and effort. You most likely need an anterior levator ptosis repair. Most likely to have a levator dehiscence ptosis. The levator in these situations is out of position and the Mullerectomy (internal ptosis repair) is not effective in this situation. Find a surgeon who will correctly repair this.
Your surgeon is correct. in my experience, it is about a coin flip whether the internal ptosis surgery would be effective if response to the eye drop test. If you are willing to accept those odds to avoid a skin incision, then you could try the internal ptosis approach. if it doesn't work, you can always move to the external approach afterwards. The only thing you have to lose is the cost of the procedure.
Thank you for your question. Phenylephrine eyedrops can be used to assess the function of one of the eyelid muscles (Muller's muscle) and routinely used for preoperative planning prior to a planned resection (i.e. tightening) of the muscle to correct the droopy eyelid (i.e. ptosis). The clinical exam is necessary to most accurately answer your question. Also, consultation with an oculoplastic surgeon is recommended, which you have already done so.