Ptosis surgery (child) Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England. Discovery has made every effort to ensure that we obtained the information in this brochure from a reputable source. We have adapted the content to reflect the South African market or healthcare environment. You should not only depend on the information we have provided when you make any decisions about your treatment. The information is meant to act only as a guide to the treatment you are considering having. Please discuss any questions you may have about your treatment with your treating healthcare professional. Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider, administrator of medical schemes.
What is ptosis surgery? Ptosis surgery is an operation to tighten the muscle that lifts your childs upper eyelid. Your surgeon will assess your child and tell you if ptosis surgery is suitable for them. About this document We understand this can be a stressful time as you deal with different emotions and sometimes you have questions after seeing the doctor. This document will give you a basic understanding about your childs operation. We tell you about the things you can do to help make the operation a success. It is also important to remember to tell your doctor about any medicine your child are on so they can manage this, if necessary. It will also tell you about what to expect after the operation while in hospital and in the long term. If you think your child is mature enough, it is best to discuss the operation with them so they can be involved in the decision too. Your doctor remains the best person to speak to about any questions or concerns you or your child may have about the operation. Is ptosis surgery suitable for my child? The levator muscle lifts your upper eyelid. In some children, the muscle does not develop fully in one or both eyes, causing the eyelid to hang down. This is called ptosis (see figure 1). a b Figure 1 a Normal eyelid b Ptosis In severe cases ptosis can interfere with the development of your childs vision. Your child may need surgery early to allow their vision to develop normally. If your child only has mild ptosis, they may become self-conscious about the appearance of their eyes as they get older. It is better to wait until your child is 5 years old, or older, before considering surgery as, usually, the older the child, the better the long-term result. What are the benefits of surgery? The position of your childs eyelid should improve. If the eyelid is interfering with the development of your child's vision, their vision should develop normally. Most older children who have successful ptosis surgery are more comfortable with their appearance. Are there any alternatives to surgery? Ptosis surgery is the only effective way to tighten the levator muscle. Copyright 2016 Page 1 of 4
Ptosis props, fitted to glasses, can keep your childs eyelid lifted up but ptosis props can be awkward to wear and do not treat the problem. What will happen if I decide my child will not have the operation? Your surgeon may be able to recommend an alternative to keep your childs eyelid lifted up. If your childs ptosis is severe, their vision may not develop normally. What does the operation involve? The healthcare team will carry out a number of checks to make sure your child has the operation they came in for and on the correct side. You can help by confirming to your surgeon and the healthcare team your childs name and the operation they are having. The operation is performed under a general anaesthetic and usually takes 45 to 90 minutes, depending on whether the operation involves both of your childs upper eyelids. Your surgeon will usually make a cut on the natural skin crease of your childs eyelid. They will place stitches in the levator muscle to strengthen its attachment to the eyelid and to adjust the height of the eyelid. Sometimes your surgeon performs the operation from the inside of the eyelid. Your surgeon will close the cut with stitches. What can I do to help make my childs operation a success? Your child should try to maintain a healthy weight. They will have a higher risk of developing complications if they are overweight. What complications can happen? The healthcare team will try to make the operation as safe as possible but complications can happen. Some of these can be serious. You should ask your doctor if there is anything you do not understand. Your doctor may be able to tell you what the risk of a complication for your child is. 1 Complications of anaesthesia Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic. 2 General complications of any operation Pain is usually only mild and easily controlled with simple painkillers. Your childs eyelid may feel slightly uncomfortable. If your child is in severe pain, let your surgeon know as this is unusual. Bleeding during or after the operation. Any bleeding is usually little. Your childs eye may look bruised and their eyelid may swell but this usually settles within a few days. If your child has any bleeding, get them to keep their head raised and press firmly on your wound for a few minutes with a clean tissue and an ice-pack. (Do not put ice directly on the skin.) If the bleeding continues, keep pressing firmly on your child's wound and contact your surgeon or go immediately to your nearest casualty unit. Infection of the surgical site (wound). It is usually safe for your child to shower after two days but you should check with the healthcare team. If your childs eyelid becomes swollen and painful after a few days, let your doctor know. An infection can usually be treated with antibiotics. Copyright 2016 Page 2 of 4
3 Specific complications of this operation Over-correction, where the eyelid is lifted too high. The surface of your childs eye may get too dry, and the eyelid may not close fully while they are asleep. The surface of your childs eye may become infected, leading to permanent scarring with damaged vision (risk: 1 in 2 500). Your child may need another operation (risk: 5 in 100). Under-correction, where the eyelid is not lifted enough. Your child may need another operation (risk: 5 in 100). Bleeding into your childs eye socket (risk: 1 in 2 500). This can increase the pressure in the eye socket and lead to permanent loss of vision. Cornea abrasion, where the surface of the eye gets scratched during the operation or by a stitch. Your child may need to wear a special soft contact lens (bandage lens) until the discomfort settles. Cosmetic problems. It is difficult to predict exactly how your child's wounds will heal. Although you will be able to see the scars at first, they will usually fade after 4 to 6 months. How soon will my child recover? In hospital After the operation your child will be transferred to the recovery area and then to the ward or day ward. They should be able to go home after a few hours. However, your doctor may recommend that your child stays overnight. Your child may need a pad on their eye. Your surgeon may tell you to use an ice-pack on their eyelid for one to two days to reduce any bruising or swelling. It is common to have a watery eye and to feel grittiness in the eye for one to two days. Your surgeon will give you lubricating eye drops for your child to help to ease the discomfort. If you are worried about anything, in hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications. Returning to normal activities Do not let your childs eyelid get wet, and they should not do strenuous exercise or bend down, until the stitches are removed. Your child should sleep with extra pillows to keep their head raised. Be gentle with your childs eyelid for at least another month. Do not let your child wear any eye make-up for at least a few weeks, and try to keep their face out of the sun. Your child should not swim for four weeks. The future The healthcare team will arrange for you to come back to the clinic regularly to check on your child's progress. It usually takes a few weeks for the eyelid to look and feel more natural. The results of ptosis surgery are permanent. Summary Ptosis surgery involves lifting your childs eyelid to improve its position and, in severe cases of ptosis, to allow their vision to develop normally. Ptosis surgery may help to improve their self-confidence later in life. Copyright 2016 Page 3 of 4
Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery for your child. Knowing about them will also help you to help the healthcare team to detect and treat any problems early. Keep this information leaflet. Use it to help you if you need to talk to the healthcare team. Acknowledgements Author: Prof Anthony King MD FRCOphth Illustrations: Medical Illustration Copyright Nucleus Medical Art. All rights reserved. www.nucleusinc.com This document is intended for information purposes only and should not replace advice that your relevant healthcare professional would give you. You can access references online at www.aboutmyhealth.org. Use reference OP10. Copyright 2016 Page 4 of 4