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Eyelid Drooping Repair(Myogenic Ptosis)
Kimberly Cockerham, MD, FACS
Central Valley Eye Medical Group
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Unilateral Acquired PtosisTypically
- one lid droops more than the other
-lid drops lower in downgaze
-lid crease high and indistinct
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Lifting the drooping
Eyelid and the “normal eyelid” now droops
At least in 5% of cases
will need surgery on other eyelid
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What to Expect on Your Exam
◼ Do you have dry eyes ? ◼ Schirmer’s tear strip
◼ Look at the surface of your eye
◼ Check for Bell’s phenomenon
Do you have excess skin ? (dermatochalasis), drooping brows (Brow ptosis) or eyelid or facial asymmetry ?
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During Your Exam; measurements and photos will be taken of your eyelids
How open is your eye ?
How strong are your muscles ?
Does the upper eyelid block your vision ?
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Photos and visual fields will be performed to determine if your insurance company will
pay for surgery
The pupil is blockedInsurance will pay for surgery
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A Visual Field will be Performed
In order for insurance to pay for your surgery, the visual field needs to show that your vision is blocked
The test will be performed with your eyelids in natural position and then with taping
Can’t see due to eyelids
Can’t see due to eyelids
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Ptosis: Treatment Options
Good muscle function
◼ Take a tuck (like hemming a pair of pants either from the front (levator advancement) or back (Mueller’s muscle resection)
Poor muscle function
◼ Frontalis sling
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Eyelid Lift: Posterior Ptosis Repair
◼ Internal approach- no external incision
◼ If phenylephrine drop lifts lid this approach will work well
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Posterior Eyelid Tuck – No External Incision
Indication: good levator function
Positive response to 2.5% Neosynephrine test
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Informed Consent
Bleeding
Infection
Undercorrection/overcorrection
Contour asymmetry
Eyelid Crease asymmetry
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Medications to Avoid Prior to Surgery
You will be given a comprehensive list of medicines to avoid:
◼ 14 days prior to surgery
Stop aspirin, advil and other pain relievers (tylenol is ok)
Stop fish oil, flax seed, Vit C and E
4 days prior to surgery
◼ Stop coumadin/plavix
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On The Day of Surgery
Arrive 30 -60 minutes before surgery
Sign Consent
Surgical hat placed
IV started with relaxing medication
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During Surgery………
Betadine Paint
Protective EyeShields
OxygenAnd WarmBlanket
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During Surgery….
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After Surgery: Ice and ointment
Before
Immediately After
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Steristrips are placed-on sutures/upper lid -As a girdle/lower lid
-to stabilize the areaof fat repositioning
Pre- Op
Immediately Post-op
Markings Intra-op
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External Approach
Eyelid skin incision
Tuck and/or excise eyelid muscle
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Mueller’s Muscle Resection
(Superior Tarsal Muscle Resection)
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Bilateral Acquired Ptosis
Pre- & Post-Op External Tuck
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Pre and Post-op External Levator Tuck
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Direct Brow Lift
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◼Myogenic Ptosis Repair Plus
◆Upper lid blepharoplasty
◆Brow lift
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Frontalis Sling
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Pre and Post-op: Unilateral Frontalis Sling