Severe Asymmetrical Eyes, Ptosis Correction

A 20-year-old female patient visited our clinic due to severe asymmetry in both eyes.

Her left eye was difficult to open, significantly obscuring her pupil, while her right eye was over-opened, revealing the sclera above. Her eyebrow usage was also severely asymmetrical, and the overall asymmetry was strikingly noticeable to anyone.

The patient stated that this condition was not congenital but developed suddenly after a severe injury to her left eye, which made it difficult to open. Subsequently, she underwent surgery for severe ptosis in one eye, and although it seemed to correct somewhat, the condition returned. Several years later, she had a second surgery, but the results were again unsatisfactory, leading her to plan a third surgery.

Due to severe ptosis, blepharoptosis correction surgery was absolutely necessary. The patient harbored significant anxiety and worry due to the two previous surgical failures. I could not precisely determine what the problem was in the previous surgeries. However, upon examination, I found that while the function of the levator muscle in her left eye was significantly weakened, it was not completely non-functional. Therefore, I believed that ptosis correction could yield better results than her current state.

Fortunately, the patient trusted me, and we proceeded with the surgery. Her left eye had severe scar tissue, likely due to multiple surgeries and the initial injury. Her right eye also had scar tissue from previous surgeries. Re-operations are generally more challenging due to severe scar tissue, making dissection more difficult. However, I carefully performed the dissection, and ultimately, sufficient ptosis correction was achieved. During the surgery, we continuously checked for symmetry by having her open and close her eyes. Ultimately, we were able to achieve a level of symmetry that presented no significant issues in daily life.

The stitches were removed after one week, and we could visually confirm that the results were well-maintained for approximately two weeks. It has now been about four months, and the results are still holding well. I anticipate that this level of improvement will continue.

The patient had many concerns due to multiple surgical failures and severe asymmetry, but I am delighted that we achieved good results. If the pre-surgical examination had shown no function in the levator muscle, this surgical method would not have been possible. I had also worried that the repeated surgical failures might be due to a lack of muscle function. Fortunately, during the examination, it was confirmed that there was some function, which led me to decide to proceed with the surgery. I am reminded once again of the importance of thorough examination and accurate diagnosis before surgery.

Frequently Asked Questions

Is ptosis reoperation difficult?

Yes, reoperation is generally more difficult. As explained in the main text, severe scar tissue from multiple surgeries made dissection challenging, but careful execution allowed for sufficient ptosis correction.

When can I see the results after correcting eye asymmetry?

Typically, you can confirm the maintenance of results for about two weeks after stitch removal. In this case, the stitches were removed one week after surgery, and the results were confirmed to be well-maintained for approximately two weeks.

What should be checked before ptosis surgery?

It is crucial to thoroughly examine and accurately diagnose the function of the levator muscle before surgery. In this case, good results were achieved after confirming that the patient's levator muscle function was not entirely absent before proceeding with the surgery.

Can ptosis occur after an eye injury?

Yes, ptosis can occur after an eye injury. This patient mentioned that her ptosis developed suddenly after a severe injury to her left eye, making it difficult to open.

Is correction impossible if ptosis surgery fails multiple times?

No, it may not be impossible. The patient in this case achieved good results by successfully correcting asymmetry and ptosis through a third surgery after two previous failures.