Day surgery management of senile ptosis

Corrective surgery for senile ptosis under local anaesthesia as day cases was carried out on 162 patients. All had 10 to 14 mm resection of the levator complex with an attached 2 mm strip of tarsal plate, always via a conjunctival approach. If indicated, simultaneous blepharoplasty was also performed. To simplify the surgical and parasurgical management, the author has progressively introduced modifications in the techniques of local anaesthesia, and in the surgical technique. These enable clear and clean isolation of the various tissue planes. The local anaesthesia including facial nerve block is given at least 30 minutes pre-operatively to prevent blepharospasm. Orbital compression is applied to achieve orbital decongestion, and an hypotensive avascular surgical field. This coupled with the use of microsurgical instruments for surgery under 3 times spectacle magnification allows proper delineation of surgical planes. The average surgical time is 20 minutes. Patients are allowed home within 2 hours of surgery, are seen for first dressing at 48 hours, and then for suture removal on the 7th post-operative day. There have been no corneal or other complications in any patient. Suboptimal cosmetic results in 2 patients were corrected by further surgery under local anaesthesia as day cases.