Congenital Eyelid Ptosis Repair (reconstruction of drooping upper eyelid).

Individualized Education

Surgical repair of congenital eyelid ptosis can take several forms. Each is best suited for specific problems and not really something you can pick and choose yourself. You will need an in person examination by Dr. Bermant. The degree of ptosis and function of available muscles must be determined during a consultation. Photographs just do not do enough to show eyelid function. We need to know about possible other factors such as associated problems. One such example would be blepharophimosis. We need to learn about possible other medical problems.

Congenital ptosis, often more severe in an infant, can improve with age. This improvement may be from better Levator function or help from the brow's Frontalis Muscle. Surgery is often between the ages of 3 and 5. Earlier treatment may be needed if the lid covers the pupil or if the child is tilting their head back to see. Examination at an early age is always best. That way education can commence and options for intervention explored.

Repair options depend on these and other factors. General techniques involve shortening working structures to lift the lid to a position where the eye can see.

Resection (shortening)

• of eyelid below muscles (Tarsal Resection)
• Muller's Muscle
• Levator Muscle

If there is inadequate function in the Muller's Muscle or Levator Muscles, then harnessing the power of the brow's Frontalis Muscles becomes another choice.

Suspension with

• Tensor fascia lata repair (tissue from the patient's thigh)
• Various synthetic suture repairs

Each of these operations is a compromise in one way or another. Shortening of structures may lift the lid out of the way but leave the eye unprotected at times. This depends how much function is left in the structures lifting the lid. While upright, gravity may pull the lid down enough to cover the eye. While laying down, or at night asleep, the eye may remain open leaving the eye exposed. Artificial eye protection may be essential at night to keep the eye from drying out. An extensive discussion of the risks, benefits and alternative methods of care belongs in the personal office consultation.

Other topics of interest:

Ptosis of the eyelid (dropping of the upper eyelid).
Ptosis classification
Muscle function and dysfunction in drooping eyelid problems.
Measuring eyelid function in eyelid ptosis.
Congenital eyelid ptosis reconstructive surgery options.
Recurrent congenital eyelid ptosis in a 26 year old black male.
Ptosis associated with paralyzed eyebrow muscle.
Ptosis associated with Blepharophimosis (congenital eyelid deformity).
Blepharoplasty (Cosmetic surgery of the eyes)
Ectropion (Drooping of the lower eyelid) Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts. Reconstruction of the lower eyelid

 

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Ptosis (drooping of upper eyelid)

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Ptosis of the eyelid (drooping of the upper eyelid)

• Simple congenital
• Acquired Myogenic (muscle related)
• Ptosis associated with Blepharophimosis (congenital eyelid deformity)
• Ptosis associated with paralyzed eyebrow muscle

Blepharoplasty (Cosmetic surgery of the eyes)

Ectropion (Drooping of the lower eyelid)

Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts.

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This page last updated on: January 22, 2012