Your eyelids are a crucial part of the body. They are movable tissue made up of skin, connective tissue, and muscle. They shield the eyes from any mechanical damage and prevent the eyes from drying out.
Floppy Eyelid Syndrome (FES) is a condition where your upper lid becomes lax and droopy. Your eyelids sag over your eyes, impairing your vision, and they can also turn inside out.
Other conditions like chronic papillary conjunctivitis and eye irritation can occur with FES. This is correctible with a surgical procedure called “ptosis surgery “.
Anatomy Of The Eyelid
Let us go through a simple breakdown of the anatomy of the eyelid. Your upper and lower eyelids have a plate of dense fibrous tissue called the “tarsus”.
The tarsus contains many fibers known as “elastin fibers”. These fibers help to maintains the form of the eyelid and support it as well.
The eyelids also have muscles attached to them. Contraction of the “orbicularis oculi” muscles causes closure of the eyelid, and contraction of the “levator” muscle of the upper lid controls the opening motion of the eyelid.
The skin covers the outer surface of the eyelid. A membrane called the “conjunctiva” covers the inner surface of the eyelid. The conjunctiva also covers the visible white area of the eyeball.
The eyelashes fringe the eyelids and serve a protective function. The eyelids also contain glands that secrete an oily fluid that lubricates its borders.
What Is Floppy Eye Syndrome (FES)?
In FES, the number of elastin fibers in the tarsus decrease, and the levator muscle relaxes and lengthens. This causes laxity of the eyelid, meaning it can easily turn inside out.
The eyelid can also droop down and obscure your vision. This condition is called “ptosis”. The degree of ptosis can range from severe to mild.
The cause of FES is yet unknown. Elastin content may decrease due to advanced age. It is commonly seen in middle-aged men who are obese.
Conditions Associated With FES
In FES, the eyelid turns inside out when a person inadvertently rubs their eyes or during sleep when their face rubs against the pillow. As a result, the conjunctiva can rub against the pillow and get irritated and inflamed.
This leads to a condition called “chronic papillary conjunctivitis”. You will get symptoms such as redness of the eyes, vision problems, and tearing.
Additionally, there is poor contact of the lax eyelids with the eyeball. The eyelids spread a film of tears over our eyeballs and keep them from drying out. Due to poor contact in FES, our eyes can dry out and damage the conjunctiva and the cornea of the eye.
FES is correctable by a ptosis correction surgery. Plastic surgeons perform “ptosis surgery ” to modify droopy eyelids and create a more widely opened eye. Surgeons use different techniques of according to the severity of ptosis and needs of the patient. A skilled plastic surgeon can easily address FES with this surgery.
Suitable Candidates For Ptosis Surgery
If you suffer from any of the following you are a suitable candidate for ptosis surgery;
- Sagging eyelids that cover more than 20% of the pupil.
- Sagging eyelids that have excess skin.
- Eyes that look tired regardless of any amount of rest, and you want bigger and more awake-looking eyes.
- Frequent headaches due to overworking of their brows and the forehead muscles to maintain their eyes open.
Ptosis Surgery Techniques
There are two major methods of ptosis surgery;
- Incisional method.
- Non-incisional method.
The Non-Incisional Method
In the non-incisional method, the surgeon makes two to three small openings on the eyelid. The surgeon passes a suture through these tiny holes and loops it around the levator muscle.
Then they tie up a part of the levator muscle and thus shortens the levator muscle. As a result, the eye opens more. Doctors perform this surgery under general anesthesia.
Surgeons recommend the non-incisional method for those who have mild to moderate ptosis. The procedure takes around one to one and a half hours. There may be some swelling and bruising for the next 3-7 days.
This method is less invasive compared to the full incisional method and therefore causes minimal scarring. Swelling and bruising are also less compared to the incisional method. The final cosmetic outcome appears after about two months from the date of the procedure when the swelling has subsided.
The Incisional Method
Doctors recommend the incisional method for those with moderate to severe ptosis, especially in compromise of the levator muscle.
In this technique, your surgeon will make an incision along the crease of your eye. Following this, they reposition the levator muscle by stitching it to your tarsus. This leads to an elevated eyelid that is cosmetically appealing.
This procedure is performed under sedation. You will not feel any pain, but you can still communicate with your doctor. Your doctor may ask you to perform certain eye movements during the procedure, so he may better judge how wide your eyes need to open.
Post-Surgical Care And Downtime
Your doctor may suggest limiting your activity for a few weeks until your eye heals. Until your doctor removes your stitches, you should refrain from strenuous activity.
Doctors advise not to rub the eye, not get the eye wet, not go swimming for about four weeks, not apply eye makeup, and keep your face out of the sun.
Ptosis surgery exposes a larger part of your eyeball to the environment than before. Hence your eyes are more prone to drying out. Therefore, the symptoms of red eyes and tearing may increase. Fortunately, these side-effects are temporary. The discomfort only persists in the early recovery stages after which the eye will adapt and normalize.
Your doctor will prescribe eye drops and ointments to keep your eyes properly lubricated. It is important to apply the antibiotic creams and/or take medication as prescribed. It is very important to follow other post-procedure instructions given by your doctor to avoid any complications after the surgery.
Most importantly, you must eat a balanced diet and maintain good health after your surgery to regain normalcy without delay.
Advantages Of Ptosis Surgery
If you have sagging eyelids that interfere with your vision, ptosis surgery can help you. Ptosis surgery strengthens your eyelid muscle. This increases the degree of eye-opening and thus improving your vision.
It also reduces the occurrence of the complications of FES like chronic papillary conjunctivitis. Hence, it enhances the overall health of your eyes.
As your eyelids sag, your face can take on a more aged appearance. Ptosis surgery can help you achieve more open eyes and a more awake, alert, and youthful look.
FES is a syndrome where your upper lids become rubbery, lax, and sag, causing ptosis and impairment of vision. It is correctible with ptosis surgery. It is imperative to consult a doctor before opting for any treatment option as they will decide what is best for you based on your individual preferences and qualities.