Doctor, I always look sleepy!

This patient complained of appearing sleepy all the time. He has problem reading because the eyelid always cover his eyes and get constant headache because he needs to life his eyebrow constantly using his forehead muscle to keep his eyes open.

Preoperative appearance.

This condition is called ptosis (from the Greek word means falling down) and is a commonly seen condition in the elderly patients. It is caused by weakness of the muscle that open the eyes (levator and Muller's muscles). The treatment of choice in this patient is to shorten the muscle so that the eyelid can be wider open. There are several ways of approaching these muscles, one of the ways is to do it from behind the eye so that there are no scars on the outside of the eyelids.

In this patient, I removed the Muller's muscle from behind the eyelid and the patient was happy with the result as he could now read without having to lift his eyelids with his fingers and the headache was gone. Below show the stages of this operation.

The eyelid was everted after instilling some local anesthesia

into the eyelid.

Local anaesthesia was injected into the space between

the Muller muscle and the levator muscle.

The conjunctiva together with the Muller muscle was cut

just above the tarsal plate border.

The Muller muscle and conjunctiva were stripped

from the levator muscle.

The desired amount of conjunctiva and Muller muscle

were excised.

The cut end of the Muller muscle and conjunctiva were sutured

to the edge of the tarsal plate.

The sutures were tied on the eyelid to avoid irritating the eyes

and the height of the eyelid adjusted.

At the end of the operation. Both eyes underwent the same

operation.

One week after the operation. Note he not longer needs

to use the forehead muscles to lift his eyelids.