67908 Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type)

Name of the Procedure:

Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (e.g., Fasanella-Servat type)

Summary

The repair of blepharoptosis using conjunctivo-tarso-Muller's muscle-levator resection, commonly known as the Fasanella-Servat procedure, is a surgical technique used to correct drooping of the upper eyelid (ptosis). This procedure involves tightening and shortening specific muscles and tissues in the eyelid to improve its function and appearance.

Purpose

This procedure addresses ptosis, which is the drooping of the upper eyelid. The goal is to lift the eyelid to a more normal position, improving vision and the cosmetic appearance of the eyelid. It can help reduce any obstruction to the visual field caused by the drooping eyelid.

Indications

• Drooping upper eyelid (ptosis) that impairs vision or affects appearance.
• Patients with mild to moderate ptosis.
• Good lid crease formation and fair muscle function.
• Patients with no significant history of other eyelid surgeries.

Preparation

• Pre-procedure consultation to assess the extent of ptosis and overall eye health.
• Measurements and photographs of the eyes may be taken.
• Patients may be advised to stop certain medications, such as blood thinners, prior to surgery.
• Fasting for a few hours before the procedure if general anesthesia is being used.

Procedure Description

1. The procedure is typically performed under local anesthesia with sedation or general anesthesia.
2. The surgeon makes an incision on the inside of the eyelid.
3. The conjunctiva, tarsus, and Muller's muscle are carefully dissected.
4. A section of these tissues is removed.
5. The remaining tissues are sutured to lift the eyelid to the desired position.
6. The incision is closed, and an ointment is applied to prevent infection.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient surgical center or hospital.

Personnel

• Ophthalmic surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Overcorrection or under-correction of the eyelid position
• Eyelid asymmetry
• Dry eyes or difficulty closing the eyelid
• Scarring

Benefits

• Improved vision by lifting the drooping eyelid.
• Enhanced appearance of the eyelid.
• Quick improvement post-surgery with results often seen immediately.

Recovery

• Post-operative instructions might include applying ice packs, using prescribed eye drops or ointments, and avoiding activities that could strain the eyes.
• Patients usually experience minimal discomfort which can be managed with over-the-counter pain relievers.
• Full recovery and final results are typically observed within a few weeks.
• Follow-up appointments are crucial to monitor healing.

Alternatives

• Observation if ptosis is mild and not affecting vision.
• Use of ptosis crutches (eyeglass attachments) to lift the eyelid.
• Alternative surgical methods such as frontalis sling operation.
• Non-surgical treatments such as botulinum toxin injections (limited efficacy).

Patient Experience

Patients may feel slight discomfort or pressure during the procedure if local anesthesia is used. Post-operatively, they might experience some swelling and bruising around the eyes, which usually subsides within a week or two. Pain is generally minimal and can be managed with prescribed or over-the-counter medications. Adjusting to the improved vision and eyelid position can take a few days to weeks.