eMedicine Specialties > Ophthalmology > Lid

Ptosis, Adult: Follow-up

Author: Adam J Cohen, MD, Eyelid and Facial Aesthetic and Reconstructive Surgery, Diseases and Surgery of the Orbit and Lacrimal System, Cosmetic Laser Surgery
Coauthor(s): Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Contributor Information and Disclosures

Updated: Nov 18, 2009

Follow-up

Further Outpatient Care

  • If surgical correction of blepharoptosis is undertaken, the patient should be observed on days 1-7 after surgery.

Inpatient & Outpatient Medications

  • After blepharoptosis surgery, a topical antibiotic ointment (with or without a steroid) should be applied twice daily for 5-7 days.
  • An oral antibiotic, that is, a penicillin derivative or a cephalosporin, may be given for 5-7 days as well.

Complications

  • Uncorrected congenital ptosis can result in amblyopia secondary to deprivation or uncorrected astigmatism.
    • An abnormal eyelid position can have negative psychosocial effects, especially in young children and teenagers.
    • Ostracism can lead to poor academic performance, loss of self-esteem, and alienation.
  • In some cases, uncorrected acquired blepharoptosis results in decreased field of vision and frontal headaches.
    • The decreased visual field can affect one's ability to perform activities of daily life.
    • Driving, reading, and navigating a flight of steps can be particularly difficult.
  • If correction of blepharoptosis is undertaken, complications related to the surgery can ensue.
    • Because most ptosis surgery is performed with the patient under local anesthesia and with monitored anesthesia care, reactions to anesthetic agents are possible complications.
    • Bleeding and poor response to anesthetic agents are potential intraoperative complications.
    • Bleeding and infection can be devastating complications in the early postoperative period. Prolonged bruising, edema, undercorrection or overcorrection of the ptosis, eyelid asymmetry, and corneal foreign body sensation can be later complications.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Correction of blepharoptosis without an appropriate examination or exclusion of medically treatable etiologies can result in poor outcomes.
  • Aesthetic and functional complications can lead to dissatisfied patients, a reduced referral base, and litigation.
  • Patients must be informed that symmetry is difficult, if not impossible, to achieve.
    • If a patient presents with unilateral ptosis, the other eyelid must be evaluated to ensure that contralateral ptosis is not present.
    • Even if contralateral ptosis is not discovered on examination, informing the patient that the uninvolved side might manifest ptosis after surgery may be prudent.
    • Also, when an eyelid is lifted, the amount of dermatochalasia may appear to be increased. The patient should be forewarned of this outcome and of the need for possible blepharoplasty.
 


More on Ptosis, Adult

Overview: Ptosis, Adult
Differential Diagnoses & Workup: Ptosis, Adult
Treatment & Medication: Ptosis, Adult
Follow-up: Ptosis, Adult
Multimedia: Ptosis, Adult
References
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References

  1. Arslan E, Demirkan F, Unal S, et al. Enhanced frontalis sling with double-fixed, solvent-dehydrated cadaveric fascia lata allograft in the management of eye ptosis. J Craniofac Surg. Nov 2004;15(6):960-4; discussion 965-6. [Medline].

  2. Beard C. Types of ptosis. In: Beard C, ed. Ptosis. 3rd ed. St. Louis: Mosby; 1981:39-76.

  3. Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. Apr 1996;103(4):623-30. [Medline].

  4. Collin JRO. Ptosis. In: Manual of Systematic Eyelid Surgery. Oxford, England: Butterworth-Heinemann; 1999:41-72.

  5. Dinges WL, Witherspoon SR, Itani KM, Garg A, Peterson DM. Blepharoptosis and external ophthalmoplegia associated with long-term antiretroviral therapy. Clin Infect Dis. Sep 15 2008;47(6):845-52. [Medline].

  6. Dutton JJ. Atlas of Clinical and Surgical Orbital Anatomy. Philadelphia: WB Saunders; 1994:120-5.

  7. Emsen IM. A new ptosis correction technique: a modification of levator aponeurosis advancement. J Craniofac Surg. May 2008;19(3):669-74. [Medline].

  8. Frueh BR, Musch DC, McDonald H. Efficacy and efficiency of a new involutional ptosis correction procedure compared to a traditional aponeurotic approach. Trans Am Ophthalmol Soc. 2004;102:199-206; discussion 206-7. [Medline].

  9. Frueh BR, Musch DC, McDonald HM. Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology. Dec 2004;111(12):2158-63. [Medline].

  10. Goldey SH, Baylis HI, Goldberg RA, et al. Frontalis muscle flap advancement for correction of blepharoptosis. Ophthal Plast Reconstr Surg. Mar 2000;16(2):83-93. [Medline].

  11. Levine MR. Manual of Oculoplastic Surgery. Oxford, England: Butterworth-Heinemann; 1996:75-105.

  12. Park DH, Baik BS. Advancement of the Müller muscle-levator aponeurosis composite flap for correction of blepharoptosis. Plast Reconstr Surg. Jul 2008;122(1):140-2. [Medline].

  13. Putterman AM. Cosmetic Oculoplastic Surgery Eyelid, Forehead, and Facial Techniques. London: WB Saunders; 1999:137-59.

  14. Sakol PJ, Mannor G, Massaro BM. Congenital and acquired blepharoptosis. Curr Opin Ophthalmol. Oct 1999;10(5):335-9. [Medline].

  15. Tsa CC, Li TM, La CS, et al. Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous frontalis suspension. Br J Plast Surg. Sep 2000;53(6):473-6. [Medline].

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Further Reading

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Keywords

adult ptosis, blepharoptosis, droopy lid, droopy eyelid, drooping eyelid, upper eyelid ptosis, lazy eye, bedroom eyes

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Contributor Information and Disclosures

Author

Adam J Cohen, MD, Eyelid and Facial Aesthetic and Reconstructive Surgery, Diseases and Surgery of the Orbit and Lacrimal System, Cosmetic Laser Surgery
Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, and Sarasota County Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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