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Eyelid Ptosis Surgery For Better Vision

Ptosis Surgery May Be Necessary When The Ptosis Has Caused The Eyelid To Partially Or Completely Block Vision. Eyelid Ptosis In Children Often Requires Aggressive Management In Order To Allow Vision To Develop Normally.

In Adults, The Most Common Type Of Ptosis Is Called "Involutional Ptosis." This Condition Is Due To A Stretching Or Thinning Of The Muscle Responsible For Lifting The Eyelids. Many People With This Condition Are Frustrated By The Strain Of Keeping Their Eyes Open Particularly When Reading. Changing Eyeglasses And Even Undergoing Other Surgical Procedures Like Cataract Surgery Does Not Solve The Problem. Eyelid Ptosis Surgery Can Not Only Improve The Appearance Of Your Eyes, But Actually Help You See Better As Well.

In Adults, Drooping Eyelids (Ptosis) Occur Slowly Over Time, And People Assume That The Eyes Have Gotten Smaller; However A Simple Eyelid Ptosis Surgery, Which Takes Less Than One Hour, Can Allow Them To See Better And Even Look Better.

Ptosis Surgery, Blepharoptosis, Low Upper Eyelid, Congenital Ptosis Congenital Ptosis, Acquired Ptosis, Aponeurotic Ptosis

Acquired Ptosis

Aetna Considers Any Of The Following Procedures Medically Necessary When The Criteria Described Below Are Met : -

  1. Blepharoplasty Is Considered Medically Necessary For Any Of The Following Indications : -
    1. To Remove Excess Tissue Of The Upper Eyelid Causing Functional Visual Impairment When Photographs In Straight Gaze Show Eyelid Tissue Resting On Or Pushing Down On The Eye Lashes (Note: Excess Tissue Beneath The Eye Rarely Obstructs Vision, So The Lower Lid Blepharoplasty Is Rarely Covered For This Indication.)
    2. To Correct Prosthesis Difficulties In An Anophthalmia Socket.
    3. To Repair Defects Predisposing To Corneal Or Conjunctival Irritation: -
      • Entropion (Eyelid Turned Inward)
      • Pseudotrichiasis (Inward Misdirection Of Eyelashes Caused By Entropion)
      • Ectropion (Eyelid Turned Outward)
      • Corneal Exposure;
    4. To Treat Periorbital Sequelae Of Thyroid Disease And Nerve Palsy
    5. To Relieve Painful Symptoms Of Blepharospasm.
  2. Ptosis (Blepharoptosis) Repair For Laxity Of The Muscles Of The Upper Eyelid Causing Functional Visual Impairment When Photographs In Straight Gaze Show The Margin Reflex Difference (Distance From The Upper Lid Margin To The Midpoint Of The Pupil) Of 2 Mm Or Less.
  3. Brow Ptosis Repair For Laxity Of The Forehead Muscles Causing Functional Visual Impairment When Photographs Show The Eyebrow Below The Supraorbital Rim.

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Congenital Ptosis

Aetna Considers Surgical Correction Of Congenital Ptosis Medically Necessary To Allow Proper Visual Development And Prevent Amblyopia In Infants And Children With Moderate To Severe Ptosis Interfering With Vision. Surgery Is Considered Cosmetic If Performed For Mild Ptosis That Is Only Of Cosmetic Concern. Photographs Must Be Available For Review To Document That The Skin Or Upper Eyelid Margin Obstructs A Portion Of The Pupil.

Ptosis Is The Medical Term For Drooping Of The Upper Eyelid, A Condition That May Affect One Or Botheyes. The Ptosis May Be Mild - In Which The Lid Partially Covers The Pupil; Or Severe - In Which The Lid Completely Covers The Pupil.

Q. When Does Ptosis Occur ?

Ptosis Can Occur At Any Age. When Present Since Birth It Is Called Congenital Ptosis. When Present In The Elderly It Is Called Acquired Ptosis.

Q. What Causes Ptosis ?

While The Cause Of Congenital Ptosis Is Often Unclear, The Most Common Reason Is Improper Development Of The Levator Muscle. The Levator Muscle Is The Major Muscle Responsible For Elevating The Upper Eyelid. In Adults Ptosis Is Generally Due To Weakening / Dehiscence Of The Levator Muscle. It May Also Occur Following Injury To The Muscle As After Lid Injuries And Eye Surgeries. Rarely It May Be Due To Myasthenia Gravis ( A Condition Where There Is Progressive Weakness Of Muscles).

Q. Why Should Ptosis Be Treated ?

Children With Significant Ptosis May Need To Tilt Their Head Back Into A Chin-Up Position, Lift Their Eyelid With A Finger, Or Raise Their Eyebrows In An Effort To See From Under Their Drooping Eyelid. Children With Congenital Ptosis May Also Have Amblyopia ("Lazy Eye"), Strabismus Or Squint (Eyes That Are Not Properly Aligned Or Straight), Refractive Errors, Astigmatism, Or Blurred Vision. In Addition, Drooping Of The Eyelid May Result In An Undesired Facial Appearance And Difficult Social Life. In Moderate Ptosis There Is A Loss Of The Upper Field Of Vision By The Drooping Upper Lid.

Q. How Is Ptosis Treated ?

The Eye Condition Ptosis Is Trated By A Specified Sugery Called Ptosis Surgery. Ptosis Is Treated Surgically, With The Specific Operation Based On The Severity Of The Ptosis And The Strength Of The Levator Muscle. If The Ptosis Is Not Severe, Surgery Is Generally Performed When The Child Is Between 3 And 5 Years Of Age (The "Pre-School" Years).

However, When The Ptosis Interferes With The Child's Vision, Surgery Is Performed At An Earlier Age To Allow Proper Visual Development. Ptosis Repair Is Usually Completed Under General Anesthesia In Infants And Young Children And Under Local Anesthesia In Adults.

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Q. What To Expect After Surgery ?

Most Patients Will Tolerate The Procedure Very Well And Have A Rapid Recovery. Cold Packs May Need To Be Applied To The Operated Eyelid For The First 48 Hours Following Surgery. Antibiotic Ointments Applied To The Incision Are Sometimes Recommended. The Elevation Of The Eyelid Will Often Be Immediately Noticeable, Though In Some Cases Bruising And Swelling Will Obscure This Finding. Most Patients Will Have Sutures That Need Removing About A Week Following Surgery. In Children, Absorbable Sutures Are Often Used.

The Bruising And Swelling Associated With The Surgery Will Usually Resolve In Two To Three Weeks. Some Patients May Need Adjustment Of The Sutures To Better Align The Lid Height. This May Or May Not Require Additional Anaesthesia Or A Trip To The Operating Room.

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