Ptosis Repair

Anesthesia Implications

Position: Supine, Bed turned 90 degrees, Bed turned 180 degrees
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Maintenance Paralytic: No

Approach – Most of these cases are done as a MAC for adult patients. General anesthesia is required for infants and children.

Surgeon Communication – Discuss the need for patient cooperation with the surgeon beforehand. Typically it will be required and only a small bolus of propofol will be needed before the surgeon injects the local. Ask the surgeon to communicate use of the cautery before use so you can reduce/cut O2 flow.

Patient Comfort – Arthritic changes may make it hard for some patients to lie flat, so careful padding is crucial. Be sure the patient is comfortable before beginning.

Patient Preparation – Thoroughly explain the events prior to the surgery (application of monitors, performance of a local block, prepping the eye, draping the face, etcetera) to the patient during preop. Verbal anesthesia is crucial. This helps tremendously to ease anxiety. 0.5-1mg midazolam may also be used.

Local Anesthetic Preparation – Before the surgeon injects the local anesthetic into the eyelid, administer 30-60mg propofol. This will be the most stimulating part of the surgery.

Cautery – Cautery may be used, so remember to turn the O2 down or off when it is.

Antibiotic – Cefazolin is the most common.

180 degree turns (general considerations): Arrange lines and monitor cords in anticipation to turn. If turning right, keep cords and lines draped to the left. If turning left, keep cords and lines draped to the right. Have a circuit extension connected. Disconnect the circuit when turning and immediately reconnect.

Ptosis, drooping of the upper eyelid, can eventually obstruct a patient’s vision, at which point surgical repair may be required. Causes of ptosis include myogenic conditions (myasthenia gravis) congenital maldevelopment, neurogenic conditions, and aponeurotic dehiscence.

The surgical approach to ptosis repair depends primarily on if there is adequate levator muscle function. This is the muscle that elevates the upper eyelid. The surgeon will make a small incision in the upper eyelid crease and will open the orbital septum.

If the patient does not have adequate levator muscle function, a frontalis sling procedure is performed to elevate the upper lid. However, this is more commonly required in children.