Drooping of the upper eyelid is a known as a ptosis. Occasionally the eyelid can affect the vision or simply look asymmetric when compared to the other side. In some cases the ptosis is present at birth (congenital ptosis) or may occur due to a condition affecting the muscle (such a myaesthenia gravis or mitochondrial disease).  In both cases the ptosis surgery is more complex than a standard ptosis repair and may require a ‘brow suspension’.

In children the reason to operate would be to allow the vision to develop normally in cases where the eyelid impairs sight. One sign that the eyelid may be affecting the sight is if your child is lifts up their chin to see.



A brow suspension uses the eyebrow / forehead muscle (frontalis muscle) to lift the eyelid rather than the normal eyelid muscle (levator muscle).

For adults, we normally perform the surgery under a local anaesthetic which is given in the operating room.  Occasionally we can give sedation at the same time if you are uncomfortable about having a local anaesthetic on its own.

In children we would perform the surgery under a general anaesthetic.

The surgery usually involves making a small incision on the front of the eyelid with 3 further small incisions just above the eyebrow and in the forehead.



We then pass a sling through these incisions to form a pentagon. This pentagon connects the forehead muscle (frontalis) to the eyelid.  Mr Norris will often use silicone as the sling material, but other materials can be used including tissue harvested from your thigh (fascia lata).  Mr Norris will discuss with you the various options.


The wounds are sutured and in children we use dissolvable sutures.  The surgery normally takes about 45 minutes per eyelid but can sometimes take longer.

After surgery the eyelid can then be lifted by raising the eyebrow, this can take some time to work normally particularly in children.


For parents it is important to know that when your child first wakes up the operated eye will not close very well. This can take a few hours to improve and in some cases a couple of days until closure is near full.  Normally we would not expect the operated eyelid to lower symmetrically with the other side when looking down (known as lid lag). This is a common side effect of the surgery and to be expected.

The risks of surgery include postoperative bleeding, scarring to the eyelids, exposure of the eye and infection. We advise that you use an antibiotic ointment in combination with a lubricant after the surgery to help reduce the risk of infection.  Mr Norris will usually also prescribe an oral antibiotic.

Occasionally we may under or over correct the position of the eyelid. Most of these complications can be corrected if required with a second operation.

The most serious risk of any eyelid surgery performed is damage to your eyesight.  Fortunately this risk is extremely rare.

On the day of surgery you will be told a time and place to come in to the hospital. You will be met by the nursing team and one of the surgical team will also see you.

If you are for day case surgery you will need to make sure that someone can be with you on the evening of surgery. If you are coming to stay the night you will need to bring some overnight clothes and toiletries for the duration of you stay. We advise that you also bring in your medications with you when you come into hospital.

This type of surgery is usually performed as a day case operation and we normally allow you to go home about 30-60 minutes after your surgery is finished (local anaesthesia) or once you are eating and drinking (general anaesthesia).

The eyelids will be bruised after surgery and you may have some blood stained tears which is quite normal initially.

The eyelid will often look a little swollen for the first couple of weeks. In addition you may find it difficult to fully close the eyes over the first couple of days. This settles down as the eyelid relaxes into its normal position.

Normally we ask that you keep the wounds around your eye clean after surgery. You can clean the wound by allowing boiled water to cool and gently dabbing the wounds with a cotton bud.

We will give you some antibiotic ointment (usually Chloramphenicol) to apply to the wounds and to the eyes after the surgery to help protect against infection and to help lubricate the eyes for two weeks. In addition you will have a lubricant ointment (lacrilube or viscotears) to help protect the eye.  Lastly you will have a short course of oral antibiotic to further prevent infection.

We normally advise that you apply ice compresses to the eyelids after surgery for three times a day for 5 minutes each time. This is to help reduce the bruising.

We will see you in the first week after surgery and then 2-3 weeks later.

You should avoid any strenuous activity including lifting heavy objects for at least two weeks and avoid swimming for three weeks after surgery.

Usually patients are quite anxious after having surgery near their eyes and most problems do settle with time. Problems that require immediate attention are the onset of new double vision, loss of vision and pain that cannot be controlled with regular painkillers.  In children if the eye becomes very injected and red then we would like you to contact us.

Please refer to the emergency contact page (in contacts) if you need advice.

Author: Mr Jonathan Norris FRCOphth