Name of the Procedure:

Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia).

Summary

This procedure is a surgical intervention to correct drooping of the upper eyelid (blepharoptosis) using a technique that involves the superior rectus muscle and a fascial sling, which is obtained from the patient’s thigh.

Purpose

The procedure is designed to address blepharoptosis, a condition where the upper eyelid droops over the eye and obstructs vision. The goal is to elevate the eyelid to its normal position, improve vision, and enhance the appearance of the eyelid.

Indications

• Presence of drooping upper eyelid(s) affecting vision.
• Congenital ptosis (present at birth).
• Acquired ptosis (develops later in life), possibly due to aging, injury, or neurological conditions.
• Patients who have not found relief from non-surgical interventions or other less invasive treatments.

Preparation

• The patient may be instructed to fast for a specific period before the surgery.
• Pre-operative assessment including a thorough eye examination.
• Possible blood tests or imaging studies.
• Discussion of medical history, including medications and allergies, with the healthcare team.
• Adjustments to current medications as advised by the surgeon, particularly anticoagulants or blood thinners.

Procedure Description

1. The patient is typically given local anesthesia with sedation or general anesthesia.
2. The surgeon makes an incision in the thigh to harvest fascia (a tissue).
3. An incision is made along the natural crease of the upper eyelid.
4. The superior rectus muscle is identified and mobilized.
5. The harvested fascia is fashioned into a sling and attached to the eyelid and the superior rectus muscle.
6. The fascia sling helps to lift the eyelid by transferring the movement of the superior rectus muscle to the eyelid.
7. The incisions are sutured closed and a bandage may be applied.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

It is usually performed in a hospital or outpatient surgical center.

Personnel

• Ophthalmic surgeon
• Anesthesiologist
• Surgical nurses
• Support staff

Risks and Complications

• Infection
• Bleeding
• Scarring
• Asymmetry between the eyelids
• Overcorrection or undercorrection
• Discomfort or pain
• Eyelid stiffness
• Rarely, injury to the eye

Benefits

• Improved vision by lifting the drooping eyelid.
• Enhanced appearance of the eyelid.
• Immediate improvement in the eyelid position, although full benefits may be seen as healing progresses.

Recovery

• Initial recovery can take a few days to a week.
• Patients will be given specific post-operative care instructions, including how to care for the incision sites and schedule for follow-up appointments.
• Activity restrictions to avoid strain.
• Use of prescribed eye drops or ointments to aid healing and prevent infection.
• Cold compresses to reduce swelling and discomfort.

Alternatives

• Non-surgical options like special eyeglasses with a crutch to hold the lid up.
• Less invasive surgical techniques, such as using a Müller muscle-conjunctival resection.
• Each alternative has its own set of benefits and limitations which should be discussed with the healthcare provider to determine the best course of action.

Patient Experience

• During the procedure, the patient should not feel pain due to anesthesia but may feel pressure or pulling.
• Post-surgery, some pain and swelling are expected, manageable with prescribed medications.
• Full recovery may involve some discomfort and adherence to follow-up care directions.