Congenital or acquired dropping of the upper eyelid. In cases with ptosis, the eyelid gap is observed to be less than 9 mm. If there is a lid position that covers the pupil, then vision will also be affected.
Ptosis; It occurs due to myogenic (muscle origin), neurogenic (nerve origin), aponeurotic (adhesion problem of levator muscle to tarsal), and mechanical reasons.
Ptosis in patients is mostly unilateral, less often bilateral. The main problem is cosmetic. In congenital ptosis seen in childhood, psychological problems and negative effects of identity development may occur.
The treatment of ptosis is surgery. Levator function (lever strength of the levator muscle) should be checked in myogenic ptosis. If the levator muscle is good to moderate in function, shortening the muscle in length (levator resection) will correct the ptosis. If the levator function is poor, sling surgery (hanging the tarsal to the frontal muscle) should be performed. In aponeurotic ptosis, reattachment of the aponeurosis of the levator muscle to the tarsal (aponeurosis surgery) should be ensured. If oculomotor nerve palsy is permanent in neurogenic ptosis, the surgical procedure should be sling surgery. In mechanical ptosis, if the mechanical cause (causes that lead to a mass effect on the upper eyelid and the conditions where the lid and bulbar conjunctiva stick together called semlepharon ) is eliminated, the ptosis will improve. The most important issue in the surgical treatment of ptosis is the preservation of eyelid function. In other words, the eye should be closed with the eyelids while the patient is asleep. If the eye cannot be closed during sleep (lagophthalmos) after the surgical procedure while trying to solve the cosmetic problem, this will bring terrible problems for the patient. Because the cornea will dry out at night (exposure keratopathy), it will lose its transparency permanently and corneal keratinization will develop. In this case, the patient's vision will decrease or even disappear. Thus, the patient will become a candidate for corneal transplantation (keratoplasty). However, the priority should still be to ensure the eyelid function. The preference for an oculoplastic surgeon, who has a good command of the anatomy of the eyelids, knows the importance and risk of the function of the eyelids, and has advanced surgical experience, will protect patients from post-operative overcorrection.
Ptosis surgery can be performed under general anesthesia or under local anesthesia. The operation time takes about 1 hour. The patient can return to work within a few days. Full recovery occurs in 4 weeks. Mostly, the obtained eyelid level does not change over time and remains the same. It should not be forgotten that the way to win without losing is with a competent oculoplastic surgeon.