PTOSIS SURGERY

PRE-OPERATIVE EVALUATION

You will need a note from your/your child’s medical doctor before admission to the hospital. Please bring this with you.

Laboratory work may or may not be needed. This will be done if necessary the day before or the morning of surgery.

Sometime in the afternoon on the day prior to surgery you will be contacted by the hospital. The time of the last feeding prior to surgery will be reviewed. This will depend on the age of the patient and the time of the surgery. The importance of an empty stomach prior to anesthesia will be emphasized. All food and fluid will need to be held after a certain hour.

PURPOSE OF THE SURGERY

This information is given to you so you can make an informed consent decision about proceeding with ptosis surgery on you/your child. You have the right to ask questions about any procedure before agreeing to have the operation.

Ptosis surgery is undertaken to correct the height of the lid in one or both eyes. This surgery can improve the field of vision; help correct significant compensatory head position and can decrease the risks of amblyopia (lazy eye) or improve its management. The age of the patient and the severity of ptosis as well as the overall function will determine the relative urgency for the timing of surgery.

Your child does not have to undergo ptosis surgery but the reason this has been recommended is because we have reached maximum results with alternative treatment. The lid position will improve significantly but with this type of surgery there is a probability of under or over corrections, some of which may require further surgery. In general, the reoperation rate short-term is less than 10%. In long-term, that is, several years in the future, reoperation rate varies between 20 and 30%. In order to improve the lid position in primary position straight ahead, we will have a lag of the lid in down-gaze, exposing the superior sclera (white part) of the eye. The eye may not close completely while asleep. Usually artificial ointment is necessary for the first couple of weeks after surgery but occasionally it needs to be continued at bedtime and/or with associated artificial tear drops during the day.

RISKS

Complications of surgery are unlikely but they may include hemorrhage (bleeding), infection, irregularities of the lid contour, extrusion of suture material and even effects on the vision including total loss of vision. Problems of bleeding, infection, glaucoma (high pressure inside the eye), retinal detachment, or reaction of the tissue in the eye (inflammation) could even lead to complete loss of the eye. These are recognized risks that can occur after ptosis surgery.
As with any surgery, there is a possibility of other complications due to anesthesia or drug reaction. It is impossible to state every complication that may occur as a result of surgery. Therefore, this list is incomplete.

RECOVERY ROOM

Following surgery the patient is taken to the recovery room where special nurses and equipment are available. Here the recovery from anesthesia is supervised. When a satisfactory state of consciousness returns, the patient is sent to a separate room. The family can rejoin the patient at this time.

POST-OPERATIVE COURSE

Eating: Until the patient is well awake nothing by mouth should be encouraged. Once awake, the patient may have ice chips or small sips of a beverage. Nausea may occur after the administration of anesthesia. Large quantities of food should be avoided in the immediate post-operative period as they can irritate the stomach. Usually the patient is able to resume a regular diet the day following surgery.

Bandages: The incisions in the operated eye(s) will be covered a greasy ointment and possibly a soft dressing. It is important to try to prevent rubbing. Rubbing can cause the stitches to open. In addition to structural damage this can cause infection.

Tearing: Tearing may occur the first few days after surgery. If it is bothersome, they can be gently wiped away with a tissue or other soft material like a towel.

Pain: Generally there is little or no pain. The eyes may be sensitive to the light due to inflammation. Over the counter medications such as Tylenol or Advil are usually sufficient. Only very rarely are prescription pain killers needed. If severe pain associated with tearing is present, you should contact the surgeon immediately.

Activity: All patients are allowed up with supervision the same day. Infants and small children may be held in the parents’ arms. Swimming and contact sports are not permitted for four weeks. Keep soap and water out of eyes while bathing.

Glasses: The eyes may be light sensitive following surgery. In this case, older patients will appreciate sunglasses or wide-brimmed hats. Younger patients may choose to close their eyes to avoid the light. If glasses are worn before surgery, they will probably be continued immediately after surgery. They may be modified at some time during the post-operative period.

Medications: After ptosis surgery antibiotic eye ointments are required. Antibiotic ointments are used to prevent infection. Additional medications such as eye lubricants may be added to the regimen.

Office visits: Generally the first checkup is on the next day following surgery. The dressing is removed. Regular visits will then be scheduled at regular and frequent intervals. If there is any problem between scheduled visits, it should be reported and additional visits can be arranged.

LONG-TERM COURSE

Treating the child after the surgery is of the utmost importance in the final visual outcome. This treatment will continue until the visual system is mature, sometime BETWEEN FIVE AND TEN YEARS OF AGE. The expected treatment may include contact lenses and/or special glasses, use of a patch over one eye, and close medical supervision. More surgery may well be needed. All this treatment is in addition to the present ptosis surgery. General medical problems may well require additional care from other medical specialists.