Corrective Eyelid Surgery – PTOSIS, ECTROPION

PTOSIS CORRECTION

The mechanism that opens the eyes is called the levator of the upper eyelids. This delicate mechanism opens and closes the eyes several thousand times every day. When the eyes are unable to open fully, ptosis (latin: to fall) of the upper eyelids is said to be present.

In general, 2 groups of patients present with ptosis. Young patients with congenital ptosis and older patients with senile ptosis.

Congenital ptosis results from congenital deficiency of the muscle that opens the eyes, resulting in inability to fully open the eyes.
Figure 1: Congenital Ptosis.
It can be surgically corrected by tightening and shortening of the levator of the upper eyelid and this can be done with the same incision that would be used for double eyelid creation.

More common is the condition called senile ptosis. With aging, the levator of the upper eyelids that opens the eyes gradually weakens and eventually tears (Levator dehiscence). This result in difficulty with opening the eyes as well as subconscious use of the forehead muscles (which raises the eyebrow and causes transverse forehead wrinkles) to assist in opening the eyes.
Figure 2: Senile Ptosis results in inability to completely open the eyes, resulting in blocked vision as well as straining of muscles around the eyes.
The patients complain of being unable to see well as well as feeling tired from straining in an attempt to open the eyes. A surgical procedure called levator advancement is used to repair the torn (or dehisced) levator aponeurosis of the upper eyelids. This can be done with the same incision as the upper eyelid blepharoplasty. After the repair, the patient will feel lighter, be able to open the eyes fully and with ease. Also, the brow and the forehead muscles (which have been strained) will ease and relax as it is no longer necessary to use these muscles to open the eyes once the levator has been repaired.

ECTROPION / LOWER EYELID MALPOSITION CORRECTION

Ectropion is a condition where the lower eyelid everts and gets pulled away from the eyeball. Lower lid malposition is a condition where the lower eyelid is pulled lower, resulting in visibility of the inferior rim of the pupil.
Figure 3: Ectropion of the right lower eyelid as a complication from a previous lower eyelid surgery.
Ectropion and lower eyelid malposition can occur in isolation or associated with each other. Ectropion and lower eyelid malposition can be the result of laxity as a result of aging or more commonly as a result of previous surgery.

Correction is complex and requires a combination of techniques, depending of the specific needs of the patients. This can range from tightening the lower eyelid, to the need to lift the midcheek to recruit more skin into the deficient lower eyelid or even the need to the use of grafts from the ear or the palate to address the deficient support of the lower eyelid.