What is ptosis? Ptosis is a common eye condition in which the upper eyelid partially or completely obscures the pupil and obstructs vision due to the weakening or loss of function of the levator muscle. A patient is diagnosed with ptosis if the upper eyelid covers the upper edge of the cornea by more than 2mm when looking straight ahead. What are the causes of ptosis? The main causes of ptosis are myogenic, neurogenic, tenosynovial, and mechanical. Myogenic refers to congenital or myasthenia gravis causes of ptosis; neurogenic includes damage to the motoneurotic nerve and mandibular transient syndrome; tenosynovial is usually caused by degeneration in old age or by trauma or surgery to the levator aponeurosis; mechanical refers to a variety of causes of ptosis due to increased upper lid weight. The most common cause of ptosis in children is congenital simple ptosis, which is caused by hypoplasia of the levator aponeurosis, while other causes include mandibular transient syndrome and microphthalmia syndrome. What are the effects of ptosis on the patient? Long-term ptosis can cause the patient to develop habits such as tilting the head, frowning, and raising the eyebrows when looking at things. Visual impairment is common and can manifest as amblyopia, myopia, astigmatism, etc. It can affect the normal development of the neck muscles and cervical spine. These defects in appearance and vision can have adverse physical and psychological effects on patients, especially children. How is the degree of ptosis differentiated? Depending on the height of the upper lid covering the cornea or pupil and the strength of the levator muscle, it can be classified as mild, moderate or severe, and the surgical options available vary. What should I do if I have ptosis? Because there are multiple causes of ptosis, it is recommended that you see an ophthalmologist, plastic surgeon or neurologist to determine the cause and diagnosis so that you can choose the appropriate treatment. What is the treatment for congenital ptosis? The main treatment is surgery, and there are several surgical options available. When is the right time to operate for ptosis? Surgery for ptosis is not better at an early age, but premature surgery may affect the outcome of the surgery due to immaturity of the child’s organs, unless severe ptosis requires earlier surgery to prevent amblyopia. If the visual acuity is not significantly affected, the surgery can be postponed and is best performed when the child can tolerate local anesthesia. What tests are required before surgery for ptosis? Routine eye examinations: visual function, refractive status, corneal and conjunctival examination, and routine fundus examination. 2. Tests to determine the cause of ptosis: neostigmine test to rule out myasthenia gravis; cocaine test; chewing jaw movement test, etc. 3. Measurement of the degree of ptosis. 4. Examination of the condition of the extraocular and frontal muscles What is Bell’s sign and can a patient with a negative Bell’s sign be operated on? Bell’s sign refers to the automatic upward deviation of the eyeball when the eyes are closed. With the absence of Bell’s sign, the cornea is easily exposed after surgery, so it is not that surgery is not possible, but the surgery needs to be conservative and postoperative care needs to be enhanced. What should I be aware of after ptosis surgery? It is important to ensure that the surgical site is clean after ptosis correction. Since ptosis often results in incomplete eyelid closure after surgery, it is easy to cause exposure keratitis and care should be taken to protect the cornea. What are the postoperative complications of ptosis correction? There is under or over correction, incomplete lid closure, lid inversion, conjunctival prolapse, and asymmetry of the upper lid crease, etc. You should follow the doctor’s advice for timely follow-up. Will the eyelid height fall back after ptosis correction? There is a possibility that the eyelid height may fall back after ptosis correction, depending on the surgical method and the patient’s recovery after surgery. Can I have a repeat surgery after correction? Yes, it is possible to reoperate, but reoperation is more difficult than the initial surgery due to scar adhesions and structural damage, so you should choose an experienced surgeon and carefully analyze the reasons for the regression before undergoing a second surgery to correct the problem.