A palavra "ptose" é o termo médico para uma pálpebra superior caída. Normalmente, a pálpebra superior é aberta pelo que é chamado de músculo elevador. O músculo vai da borda superior da órbita do olho até a pálpebra superior. Ele se abre e entra no tecido conjuntivo, o que dá à pálpebra superior sua força.
A ptose adquirida geralmente ocorre de ambos os lados em adultos e pode ter várias causas. O ponto de fixação do músculo elevador na pálpebra superior desliza para cima com o tempo: o músculo funciona bem, mas não consegue mais elevar a pálpebra superior à altura correta. Em casos graves, a pálpebra superior pode cobrir parcial ou completamente a pupila.
A ptose pode reduzir o campo de visão e também danificar a região da coluna vertebral entre os ombros e a base do crânio, enquanto os pacientes tentam equilibrar o limitado campo de visão, levantando constantemente o queixo.
O sucesso da operação também depende de quão bom é o poder remanescente do músculo da pálpebra. Podem ser usadas diferentes abordagens, desde a cirurgia Fasanella-Servat (ver abaixo) até ressecções e reinserções do músculo elevador.
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.
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.
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.
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.
