A drooping of one or both upper eyelids also called ptosis is not only eye-catching but can also lead to strong functional impediment when part of the pupil and thus part of the visual axis is covered.

There are various causes for ptosis: 

• A damage of the levator (damage of the lifting muscle of the eyelid or its tendon) normally caused by sagging tissues in older age.
• An innate ptosis, mostly caused by an abnormality of the lifting muscle of the eyelid.
• A nerve damage  of one of the muscles responsible for the lifting of the eyelid.
• Muscle diseases (e.g. myasthenia gravis)

As soon as the cause is determined by your Smile Eyes expert a surgical correction can be taken into consideration. From the various techniques we will find the appropriate one for you.

A frequently used technique is the resection of the anterior levator muscle – that is the surgical reduction of the lifting muscle which leads to a lifting of the upper eyelid.

If you are affected by an ectropion the edge of the lower eyelid is folded outward.
In most cases there is a tear drizzle in the eye since with the edge of the lower eyelid folded outward also the lacrimal point is outward folded. Thus the excess tear film cannot drain into the lacrimal duct; it flows out of the eye via the flaccid edge of the lower eyelid. Moreover the conjunctiva of the affected eye is prone to inflammation because it dries out easily as the lid edge does not fit tightly anymore.

Frequently the cause for this is an age-related sagging of the horizontal tension of the lower lid as well as of its suspension. Traction of scars below the lower lid can cause an ectropion. 

Contrarily, with an entropion the lid edge is turned towards the eye – this leads to a constant scratching of the eyelashes on the surface of the eye.

In most cases we suggest a surgical correction: the edge of the lower lid is lifted and brought back into its original position.

Tissue changes around the eyelid need to be examined by an ophthalmologist. We differentiate between benign tumours, locally restricted malign tumours, and strewing malign tumours.

A determination of the various types is not always possible with a visual diagnosis with a split lamp - quite often for diagnosis a pathologist has to carry out a biopsy with subsequent tissue sample.

The resection of benign growths can be carried out in a single surgery. Surgery of malign tumours needs to be split in two or more interventions. In a first step the tumour is resected. The retrieved tissue is sent to the institute of pathology and the tissue examined thoroughly. The pathologist can judge if it was possible to remove the tumour completely or if there are remaining residues. These facts determine if the operational wound can be sutured or if a secondary intervention is needed. 

The wound is covered by direct skin adaption, advanced flaps or free skin transplants.

Prior to surgery an extensive consultation takes place.

Prior to any surgery you will undergo a thorough examination by one of our ophthalmologists of our Smile Eyes centers.  Chances and risks of surgery will be explained extensively. It is an out-patient surgery with local anaesthesia and takes about one hour if both eyes are treated. On the day of surgery it is best that family or friends accompany you to drive you home after the intervention.

Preliminary examinations

Prior to surgery several examinations are necessary:

An extensive examination of the eyes, an evaluation of the eyelids and of the alignment of the lids are carried out to determine the surgical proceeding.

The general health condition of the patient as well as his medication - especially blood diluents - is controlled by the general practitioner. These examinations serve to guarantee the highest possible safety.

Prior to surgery

Surgery is carried out under local anaesthesia, patients are allowed to eat up to 6 hours and drink up to 2 hours before surgery. Diabetics should clear their medication with their general practitioner. 

Prior to surgery our anaesthetist supplies the patient with medication for sedation and relaxation. He also monitors the patient during surgery (ECG, blood pressure and pulse measuring). There is no need for general anaesthesia due to the application of local anaesthesia that sedates the eye and the lid zone and leads to insensitivity to pain. During surgery the patient is awake and responsive. 

Prior to surgery the upper part of the face is cleansed thoroughly with a disinfecting solution and the face covered with sterile cloths.

During surgery

Normally surgery is over in about 60 minutes. The same span of time applies for after-care. Generally speaking, the whole stay for a lid correction in the Smile Eyes Clinic is less than 3 hours.

After surgery

The operated eye is covered with an ointment bandage. The bandage is removed after one hour post-operative and the eyes are examined. The doctor decides whether you leave the clinic with or without bandage.

One week after surgery the stiches are removed.

After a certain monitoring phase we let you go home. You are not allowed to drive a vehicle so please bring an accompanying person. For several hours after surgery you should not be alone.

That´s what you should  pay attention to in the following days and weeks

It is very important that after surgery the patient rests for several days and cools the eyes. Physical activities are to be avoided.

In the first days after surgery the formation of haematoma or an irregular swelling of the lids can occur. It is also possible that the lids cannot be closed completely and an asymmetry between the two sides can be noticed. As soon as the stitches are removed, the feeling of tension around the eyes disappears. 

Do not squeeze or rub your eye in any event until the wound has healed and the sutures are removed.

In the first days after surgery your face should not be sprinkled with water. If you wash your hair, be careful to incline your head backwards. During the first days you should avoid getting your eye in contact with soap.

Physical effort and sports such as swimming or diving, cycling or sauna should be avoided until your surgeon gives his permission, normally at the latest after two weeks.

Generally lid surgeries bear an extremely low risk. The very rare complications are wound infections, after-bleeding, injuries of superficial vascular or nerve branches, visible scar formation or pigment disorder or reactions to the local anaesthesia. Further side effects can be a blurred vision for several days, a swelling of the eye lids, haematoma, or a slight asymmetry of the eyes.

As a patient you can contribute greatly to further minimize the risks by respecting the instructions of the surgeon before and after surgery.