Ptosis Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Ptosis surgery corrects drooping of the upper eyelid (blepharoptosis) that partially or fully covers the pupil. It restores the lid to its normal position by tightening or advancing the levator palpebrae superioris muscle or, for poor levator function, suspending the lid to the frontalis muscle with a sling.

Surgical correction is indicated for ptosis causing visual field obstruction (functional ptosis), amblyopia risk in children from visual axis occlusion, chin-up head posture compensation, significant cosmetic asymmetry, or severe ptosis from myasthenia gravis, Horner syndrome, third nerve palsy, or aponeurotic disinsertion in adults.

For good levator function (greater than 5 mm excursion), levator resection via an anterior skin crease incision or posterior conjunctival approach (Fasanella-Servat or Mullerectomy) is performed. For poor levator function (under 4 mm), a frontalis suspension with silicone rod or autologous fascia lata sling connects the lid to the brow muscle for lid elevation.

Post-operatively, ice packs and head elevation reduce bruising and swelling. Antibiotic ointment is applied for 1–2 weeks. Mild lagophthalmos (incomplete lid closure) is common and resolves as swelling subsides. Lubricant eye drops protect the cornea. Final lid position and height assessment occurs at 3–6 months.

Risks include under-correction requiring revision (10–20%), over-correction with lagophthalmos and corneal exposure, asymmetry, lid crease abnormality, haematoma, suture granuloma, and damage to levator muscle. Children may require glasses for residual amblyopia after ptosis correction.

Ptosis surgery achieves satisfactory lid position in 80–90% of patients at one year. Revision rates are 10–20% due to under-correction or asymmetry. Children treated early for amblyogenic ptosis achieve normal visual development in over 90% of cases with early surgical intervention combined with occlusion therapy.