So I'm back from my 4hr dr appt yesterday and I'm trying to figure out what I should do regarding some plastic (not cosmetic, there is a difference) surgery.
Background:
My left eye lid droops and it interferes with my vision. I scored a 0 on a visual field test in that eye. Basically I cannot see out of it at all "using normal function". I compensate by using my eyebrow muscles and tilting my head back in order to see. This is not me but here is a pic that is demonstrates what I am dealing with:
http://2.bp.blogspot.com/_0HSm2PoSbVU/TQxBdg4BxXI/AAAAAAAAAEM/tpodOLlsWFA/s1600/DSC02907.JPG.
I have been to 4 oculoplastic surgeons so far (as well as some other evals for things like an AVM, MG, etc.) and had 3 surgeries that raise the levator muscle. This has been over the course of the last 10 years but I have had some degree of this condition for 16 years. It is very unusual for someone at 16 to develop this condition, it is mostly congenital and surgery is performed during youth. The success rate is very high for those cases. All efforts thus far only provided temporary, imperfect, correction. I decided to have another go at it with a different doctor again and see what could be done.
Where I am right now is my eye lid droops as much as it did originally (or worse?) and now I cannot fully close the eye since the last surgery. I have to use eye ointment every night in order to keep it from drying out or I will wake up with an "eye ache". Dry eye condition is amplified by the fact I had lasik done, which destroys nerves in the eye.
Option 1: Do Nothing
The downside to doing this is that 1) I cannot see properly 2) I may develop neck problems due to my continually tiling my head back. The pros are to avoid another surgery and possibly make things worse (either from a complication or being able to close it even less).
Option 2: Repeat levator muscle surgery. This was my least desired option going into my appt since it was already done 3x and failed. However, the new dr thought this was still my best option and seemed like he wouldn't feel comfortable not trying it again first. He brought in another dr during my appt and she agreed. The pro that it should at least mostly fix it in the short term and is the least invasive of the options. The cons are that it might not work and might make not being able to close my eye worse.
Option 3:
Silicone sling surgery. The levator muscle is severed and a silicon sling is connected from the eye lid to the frontalis (eye brow) muscle. The pro is the sling can be easily adjusted post surgery. The con is that it is mostly a temporary solution since the sling can detach or need to be replaced. This option is mostly a trial for option 4 however he indicated for some patients it can be a permanent solution. The cons are that I have to retrain how I open my eye and I definitely will not be able to fully close it, so I will have a greater reliance on artificial tears.
Option 4:
Fascia sling surgery. Same as option 3 except that tendon from the thigh muscle is harvested and used in place of the artificial material. The pro is that the solution uses my own tissue and will grow into place. It is considered a permanent solution, however the sling cannot be adjusted post surgery. The main con is trauma to my leg ("You'll be gimpy for a while"). However, this option is generally considered the standard treatment.
Option 3/4b:
Option 3/4 only relate to the broken eye lid, however correction to just that eye was not the recommended approach. Due to the fact that different techniques will be required to open my eyes, the lids will still be uneven or I may not develop the technique at all since I would still have 1 functional eyelid. He indicated that it would be better to perform the same surgery to my good eye so that they are even and I have to work them the same. The 2nd doctor that came into my appt was strongly against touching my good eye but she wasn't as experienced (a fellow).
What would you do? Right now I decided to go with their recommendation and repeat the levator surgery. Other than the hassle/risk of repeated surgery there is little reason not to try it first again. I am scheduled it for July 3. I am not too optimistic that it will last more than a couple years and at that point I will probably try option 3 (I actually like this dr so I don't see a reason to go to someone else) and if I adjust to the sling and it gets to a point where it needs to be replaced, go full out 4b. Option 4 (not b) is what I was initially interested in going into the appt but I had not considered the issues mentioned in the "b" variant.
Background:
My left eye lid droops and it interferes with my vision. I scored a 0 on a visual field test in that eye. Basically I cannot see out of it at all "using normal function". I compensate by using my eyebrow muscles and tilting my head back in order to see. This is not me but here is a pic that is demonstrates what I am dealing with:
http://2.bp.blogspot.com/_0HSm2PoSbVU/TQxBdg4BxXI/AAAAAAAAAEM/tpodOLlsWFA/s1600/DSC02907.JPG.
I have been to 4 oculoplastic surgeons so far (as well as some other evals for things like an AVM, MG, etc.) and had 3 surgeries that raise the levator muscle. This has been over the course of the last 10 years but I have had some degree of this condition for 16 years. It is very unusual for someone at 16 to develop this condition, it is mostly congenital and surgery is performed during youth. The success rate is very high for those cases. All efforts thus far only provided temporary, imperfect, correction. I decided to have another go at it with a different doctor again and see what could be done.
Where I am right now is my eye lid droops as much as it did originally (or worse?) and now I cannot fully close the eye since the last surgery. I have to use eye ointment every night in order to keep it from drying out or I will wake up with an "eye ache". Dry eye condition is amplified by the fact I had lasik done, which destroys nerves in the eye.
Option 1: Do Nothing
The downside to doing this is that 1) I cannot see properly 2) I may develop neck problems due to my continually tiling my head back. The pros are to avoid another surgery and possibly make things worse (either from a complication or being able to close it even less).
Option 2: Repeat levator muscle surgery. This was my least desired option going into my appt since it was already done 3x and failed. However, the new dr thought this was still my best option and seemed like he wouldn't feel comfortable not trying it again first. He brought in another dr during my appt and she agreed. The pro that it should at least mostly fix it in the short term and is the least invasive of the options. The cons are that it might not work and might make not being able to close my eye worse.
Option 3:
Silicone sling surgery. The levator muscle is severed and a silicon sling is connected from the eye lid to the frontalis (eye brow) muscle. The pro is the sling can be easily adjusted post surgery. The con is that it is mostly a temporary solution since the sling can detach or need to be replaced. This option is mostly a trial for option 4 however he indicated for some patients it can be a permanent solution. The cons are that I have to retrain how I open my eye and I definitely will not be able to fully close it, so I will have a greater reliance on artificial tears.
Option 4:
Fascia sling surgery. Same as option 3 except that tendon from the thigh muscle is harvested and used in place of the artificial material. The pro is that the solution uses my own tissue and will grow into place. It is considered a permanent solution, however the sling cannot be adjusted post surgery. The main con is trauma to my leg ("You'll be gimpy for a while"). However, this option is generally considered the standard treatment.
Option 3/4b:
Option 3/4 only relate to the broken eye lid, however correction to just that eye was not the recommended approach. Due to the fact that different techniques will be required to open my eyes, the lids will still be uneven or I may not develop the technique at all since I would still have 1 functional eyelid. He indicated that it would be better to perform the same surgery to my good eye so that they are even and I have to work them the same. The 2nd doctor that came into my appt was strongly against touching my good eye but she wasn't as experienced (a fellow).
What would you do? Right now I decided to go with their recommendation and repeat the levator surgery. Other than the hassle/risk of repeated surgery there is little reason not to try it first again. I am scheduled it for July 3. I am not too optimistic that it will last more than a couple years and at that point I will probably try option 3 (I actually like this dr so I don't see a reason to go to someone else) and if I adjust to the sling and it gets to a point where it needs to be replaced, go full out 4b. Option 4 (not b) is what I was initially interested in going into the appt but I had not considered the issues mentioned in the "b" variant.
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