Lid Surgery

Ptosis in an Adult

       Ptosis -- an upper eyelid that droops -- can give you a headache from the effort of holding it open wider. But the condition is usually not serious unless the droopy lids interfere with vision. Ptosis is pronounced TOE-sis. Blepharoptosis (BLEF-ur-ahp-TOE-sis), the full name of this condition, comes from the Greek and means "falling lid."


What Causes Ptosis? 

        A muscle (the levator) holds the upper eyelid in proper position and moves it up and down. Anything that affects this muscle will also affect the lid position. In an adult, most cases of ptosis come on gradually after age 60 or so as part of the normal aging process. The levator tendon (the fibrous connection between the levator muscle and the lid) stretches, loosening its attachment to the eyelid and causing it to sag. This age-related ptosis is called "involutional."

        Less common causes include injury, previous eye or orbital surgery, and neurological and muscular problems. Or the levator muscle or its nerve supply can be involved in a systemic condition, such as diabetes or myasthenia gravis. Occasionally, a drooping lid in an adult has actually been present since birth but was never treated. (Check by looking at an old photograph.) Blood tests, x-rays, or other tests are sometimes needed to determine the cause of a ptosis. If treatment is indicated, the tests can help with planning the best type of treatment.


        If the ptosis is not bothering your vision, and you are not concerned with its appearance, nothing needs to be done about it. Should you decide to have the eyelid repaired surgically, the exact procedure used will depend on the cause. For example, if a levator tendon has pulled away from the lid, reattaching the tendon can correct the ptosis. If the muscle is weak, a surgical tuck will tighten the tendon to provide additional lift.

        Surgery is usually performed on an outpatient basis under local anesthetic, and it takes less than an hour. After surgery, ice compresses are applied to lessen swelling. Over-the-counter pain medication, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Advil) can reduce any discomfort you might have. You will probably want to stay home and rest the first day, and you should avoid strenuous exercise for about one week. Other than that, there is no need to limit your activities. Patients vary in their response to surgery, but generally the swelling is gone within about two weeks.

What Are the Risks of Surgery?

 Sometimes the operated eyelid does not close well for a few weeks after the surgery. The partially open eye allows excessive exposure to the air, and this can cause the surface of your cornea to become dry, especially during sleep. You awaken to a burning or scratchy sensation in your eye. The problem is usually temporary, and lubricating drops and ointments can alleviate the dryness and the discomfort. If it persists (which is rare, and most likely to happen if the ptosis was severe or if the levator muscle is very weak), the lid may need to be lowered surgically.

        Less likely is the possibility that the levator muscle will not respond as expected, resulting in lid positions that do not "match" one another. If that happens, a second operation may be necessary to readjust the alignment.

        As with any surgery around the eye, there is a small risk for bleeding, infection, scarring, double vision, or even loss of vision. Fortunately, these complications are very rare, and if they are discovered quickly, most can be treated successfully.     


        After the sutures are removed and the swelling has subsided, you may be surprised not to see a scar. That is because the incision site is usually hidden in a natural eyelid crease or on the underside of the upper lid. The surgical correction of ptosis is normally uncomplicated and achieves the desired result. Most patients are delighted with their improved appearance and their unobstructed vision.

To learn more about Ptosis and the health care we can provide,

please call us at 208-523-6868


 An ectropion (ek-TROW-pee-on) is an outward-turned eyelid that leans away from its natural position against the eyeball. Usually only the lower lids (one or both) are involved, though the upper lids can also be affected. Most people find the condition only annoying, but occasionally it can pose a problem, even a danger to the eye. 

What Makes an Ectropion Serious?

        The eyelids protect and lubricate the eyeball. When you sleep, they cover the eyes and keep them from getting dry. When you are awake, each sweep (blink) of the upper lid moving over the eyeball acts as a "windshield wiper," moistening and cleansing the delicate tissues, while the lower lid helps cover and moisten the lower part of the eye. When you have an ectropion, moisture is lost, the surface can dry, and the eye can develop ulcers and become infected.


        Ectropion of the lower lid: A normal lid maintains a thin layer of tears over the eyeball and aids their natural flow toward the tear drainage channels near the nose. If the lid falls (or is pulled) away from its normal position, the eye feels full of tears and waters all the time, and the tears may even run down your cheek. Despite the excess tears, you may have a continuous sensation of dryness or burning in the eye or a feeling of a foreign body. As the condition progresses the lid pulls farther away from the eye. If the eyeball dries too much or begins to ulcerate, it will become bloodshot, irritated, and painful.

        Ectropion of the upper lid: Loss of the lid's "windshield wiper" effect causes continual dryness and blurry vision. Your eye compensates by generating more moisture, which can cause further blur and also adds to the feeling that the eye is watering all the time.  However, most of the watering occurs because the lid is not positioned properly, which prevents normal tear drainage into the nose.

What Causes an Ectropion?

        The eyelids are held against the eyeballs by the natural tension of the eyelid muscles and the tendons that support them. With aging, these muscles do not function as well, and the lids fall away from the eyeball, especially when you lean forward. An ectropion may also result from scars after lacerations or surgery near the eyes, from burns, from disease (such as facial paralysis), or from some degenerative skin conditions that cause the lids to pull away from the eye.


        Treatment varies according to the cause, your age and occupation, the severity of the condition and the symptoms, whether it is progressing, and whether you have had previous treatment or surgery.

        If your ectropion is slight, various eye drops and decongestants may offer relief. If the lid is actually pouting outward, dryness of its inner surface may be relieved with lubricant ointments. Depending on your symptoms, you may choose to live with a mild ectropion. That choice is satisfactory if the appearance doesn't bother you, if drying is not excessive, and if there is no ulceration or infection of the eyeball.

        For a severe case with severe symptoms and discomfort, or if there is ulceration of the eyeball, plastic surgery of the lids becomes necessary. In most cases, surgery involves removing the excessive tissue and tightening the remaining tissue. Although surgery is usually curative, some patients achieve only partial improvement.

       Sometimes the ectropion recurs as the tissues continue to age and lose elasticity, and surgery may again be needed to solve the problem.


To learn more about Ectropion and the health care we can provide,

Please call us at 208-523-6868


Entropion (en-TROW-pee-on) is an abnormal inward turning of an eyelid -- usually the lower lid -- toward the eyeball. From this position, the eyelashes can rub against the eyeball. The rubbing is irritating, and if it continues for long can result in corneal scratches, abrasions, ulcerations and infections. If a corneal ulcer or other serious complication should develop, it is likely to be painful and could significantly impair your vision.
The lashes brushing against your eye can make it feel scratchy and gritty, as if a foreign particle were in it. It may also feel watery most of the time. Many patients seem to get caught in a vicious cycle that makes the condition worse: as the irritated eye waters, they wipe it with a tissue, which causes more irritation and more spasm of the muscle that pulls the lid in against the eyeball, which causes more irritation and watering.

What Causes an Entropion?


 As people get older, the attachments of the muscles that move the eyelids up and down loosen, to the point that the lids no longer fit snugly against the eyeball. Without the firm anchoring of muscle attachments, the lids and lashes may roll inward.


 Any eye infection (which makes an entropion temporarily worse) will be treated with eye drops or ointment. At the same time, the lid will be taped shut to stop the eyelashes from rubbing against the eyeball. An anesthetic may be injected into the lid to paralyze the muscle that rolls the eyelid inward.

If you have chronic corneal irritation or ulceration that can endanger sight, plastic surgery will be necessary to remove excess tissues and tighten some parts of the lid. This will get the eyelashes away from the eyeball and relieve the irritation. To help keep the eye moist, you may need to use eye drops and ointments after surgery.

Sometimes the entropion recurs as the tissues continue to age and lose elasticity, and surgery may again become necessary to solve the problem. 

To learn more about Ptosis and the health care we can provide,

please call us at 208-523-6868