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Acquired Ptosis (Drooping Eyelids)

Definition

The word “ptosis” is the medical term for a drooping upper eyelid. Normally, the upper lid is opened by what’s called the levator muscle. The muscle runs from the upper edge of the eye socket into the upper eyelid. It fans out and enters the connective tissue, which gives the upper lid its strength.

The acquired ptosis usually occurs on both sides in adults and may have various causes. The point of attachment of the levator muscle on the upper eyelid slips upwards over time: the muscle works well, but it can no longer lift the upper eyelid to the correct height. In severe cases, the upper lid may partially or completely cover the pupil.

Ptosis can narrow the field of vision and also damage the even damage the region of the spine between the shoulders and the base of the skull, as patients try to balance the limited field of vision by constantly raising their chin.

The success of the operation also depends on how good the remaining power of the eyelid muscle is. Different approaches can be used, from Fasanella-Servat surgery (see below) to levator muscle resections and reinsertions

Causes

  • An age-related relaxation of the connective tissue
  • Wearing hard contact lenses. These stretch the levator muscle. Approximately 10% of all wearers of hard contact lenses experience slowly progressive ptosis after approximately 10 years
  • Previous eye surgeries in which a lid speculum was used
  • Previous severe inflammation or accidents that resulted in massive swelling of the upper lid
  • In very rare cases, ptosis is triggered by an as yet undetected muscle disease or neurological condition (myotonic dystrophy, myasthenia gravis)

The operation

In principle, there are two different surgical techniques that can be used to treat ptosis. Which one is chosen depends on the condition of the levator muscle and the extent of ptosis. After the examination, we will discuss the findings together with you and plan the further course of action with you.

Levator reinsertion

Here, the levator muscle is attached to its original attachment in the upper lid. This operation is performed under local anaesthesia because it is important that we can check the height of the upper lid several times during the operation.
Following a skin and muscle incision, the levator muscle is exposed and re-attached to the connective tissue plate of the upper lid (tarsus). Then we check the level of the upper lid and adjust the height until a satisfactory result is achieved. If there is excess skin on the upper lid, it may also be removed during surgery. If this does not happen and the upper lid is (correctly) higher after surgery, skin excess will be even worse.

Fasanella-Servat

Here, the connective tissue plate of the upper lid is shortened from the inside. This operation lasts about 30 minutes and is performed under general anaesthesia. We perform a Fasanella Servat operation when there is a low amount of ptosis.

The “perfect” symmetry

In about 15% of cases, you’ll see a good result for each eye after surgery, but there is a certain asymmetry between the eyelid opening of both eyes. It is not always possible to avoid this because wound healing can also change lid height.

But a perfect symmetry of both upper eyelids is rare – even in healthy eyes. A certain, small difference in the sides after the operation should be tolerated.

With this surgery, it’s all about patience, patience and patience: the final lid height stabilizes only about 6 months after surgery. Until then, there may be under- or overcorrection. Therefore, it is particularly important in this operation to be patient: If after 6 months, a significant difference (> 2mm) before, then we will possibly suggest a re-operation.

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Augeninstitut ELZA
4.8
Based on 109 reviews
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mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100%... achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!read more
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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Augeninstitut ELZA
4.8
Based on 109 reviews
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