Eye Ptosis Surgery Internal Approach

The internal approach to ptosis repair may be directed toward the Müller muscle, the tarsus, or the levator aponeurosis. Müller muscle resections are used in patients who have an adequate upper eyelid position and need repair of minimal ptosis (2 mm). In this procedure, the surgeon turns the eyelid inside out and shortens the eyelid muscles from the inside of the eyelid.

at-a-glance

Eye Ptosis Surgery Internal Approach

avg. recovery
6 weeks
permanence
Is permanent
application
Not Applicable
surgical
Yes
cost
$2000 - $5500

About the Procedure

A sterile marking pen is used to mark the upper eyelid skin prior to injection of local anesthetic. The eyelid crease incision may be marked along the patient’s natural eyelid crease, however, in patients with upper eyelid ptosis the eyelid crease may be displaced superiorly or poorly defined. Therefore, the crease may be measured and marked according to the patient/surgeon preference in regard to gender, ethnicity, anticipated prominence of the upper eyelid skin fold, and brow position. The upper eyelid is everted over a Desmarres retractor and a caliper is used to measure the distance above the superior tarsal margin. A 6-0 silk suture is passed through conjunctiva centrally and 7 mm nasally and temporally. A toothed forceps is used to firmly grasp the conjunctiva and Müller’s muscle between the superior tarsal border and the silk marking suture in order to separate Müller’s muscle from the underlying levator aponeurosis. With the clamp held vertically, a double-armed 5-0 plain gut suture is run in a horizontal mattress fashion approximately 1.5 mm below the margin of the clamp along its entire width in a temporal to nasal fashion. The suture is passed through the conjunctiva and superior tarsal margin on one side of the clamp and conjunctiva and Müller’s muscle on the opposite side of the clamp. In effect, the conjunctiva–Müller’s muscle complex is advanced and reattached to the superior tarsal border. The suture passes are positioned adjacent to one another on the tarsal side and 2–3 mm apart on the opposite side of the clamp. A surgical blade is used to excise the tissue within the clamp by cutting between the suture and the clamp.

The goal of ptosis surgery is to elevate the eyelid for better vision and cosmetic appearance.

Concerns

Eye Ptosis Surgery Internal Approach addresses concerns such as:

Recovery Notes

Limit activities for 1 week after surgery. Avoid rubbing eyes or doing anything that could potentially irritate the eyes. Bandages are not necessary. Ptosis surgery lifts the eyelid leaving a larger surface area of the eye exposed and prone to dryness. The eyelid can become inflamed and may not be able to close completely. For these reasons, it is possible to develop new or worsening dry eye syndrome. Medications or other treatments may be recommended to keep the eye properly lubricated.

Ideal Candidate

It is recommended for people with ptosis who have strong levator muscle function and only have 1-2 mm of ptosis.

Not Recommended For

Ptosis surgery is not recommended for patients with corneal sensitivity and severe dry eye syndrome. Although not a complete contraindication, patients with thyroid disease, Bell phenomenon, and poor eye muscle function may produce lagophthalmos.

Side Effects

Side effects from ptosis surgery may include prolonged bruising, edema, under-correction or over-correction of the ptosis, eyelid asymmetry and abnormal shape (i.e. peaking), and corneal foreign body sensation.

Pros
  • Faster procedure
  • Less post-operative swelling
  • Less post-operative lagophthalmo
Cons
  • Not as effective for patients who have more than 2 mm of ptosis

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