Mayor Thomas M. Menino is scheduled to undergo surgery Wednesday to repair drooping eyelids, a medical condition that has slowly obscured his vision over the past decade and is most likely a consequence of age.
Menino will remain awake but sedated during an hourlong procedure to bolster tendons that control the upper eyelids. Gradually, the tendons have stretched and stopped working properly, leaving the mayor’s eyelids so low they cut across the middle of his pupil and obscure his sight.
“It’s like looking out a porthole with a shade down,” said Dr. Mami A. Iwamoto of Massachusetts General Hospital, who will perform the outpatient surgery. “The shade interferes with the view out the porthole.”
Iwamoto described the procedure as a common surgery that will allow Menino to return to his feet quickly. But the incisions in the eyelids will cause significant swelling and bruising on his face, forcing the mayor to cancel public appearances for about a week.
“I tell my patients not to have this done before the prom, because they are going to be black and blue,” said Dr. George B. Bartley, an ophthalmologist at the Mayo Clinic in Rochester, Minn., who did not have specific knowledge of Menino’s case but performs similar surgeries. “Their best friend is an ice mask for the first few days.”
Over the next week, aides plan to hold briefings at Menino’s home on Chesterfield Street in the Readville section of Hyde Park. So many City Hall meetings have been conducted at Menino’s home while he recovered from other ailments that the mayor dubbed it “Camp Chesterfield,” a play on “Camp David,” the presidential retreat in rural Maryland.
Menino has aged in the public spotlight. He became mayor in 1993 at age 50. He now faces his 70th birthday in December as he contemplates running next year for a sixth term.
Because of his position, Menino’s medical issues have been exhaustively cataloged by the media, from a minor outpatient procedure to remove a cataract in his right eye in August 2010 to a three-hour surgery on his back in July 2003 to try to prevent the recurrence of a rare form of cancer. He has been hospitalized roughly a dozen times over the past two decades for afflictions that have included kidney stones and Crohn’s disease, a chronic inflammation of the intestines.
During this term, Menino has made more frequent trips to the hospital — and spent more time convalescing at home. Days after winning a fifth term in 2009, Menino fell, severed a tendon in his left knee, underwent surgery, and spent weeks on crutches.
The next year, Menino contracted a bacterial infection in his left elbow during a trip to Italy that required two stays in the hospital. Weeks later, doctors operated on his left knee, forcing him back on crutches.
Aware of gossip about his health, Menino tried to turn vulnerability into an asset. Two weeks after his second knee surgery, he was scheduled to give his annual State of the City address in January 2011. That night, he entered Faneuil Hall to a brass quintet playing “Gonna Fly Now,’’ the theme song from the movie “Rocky.’’ Using crutches and greeted by cheers and laughter, Menino grinned like a champion.
More medical issues arose in 2012. In January, Menino had minor surgery to remove a cancerous growth from his nose. A month later, he broke a toe and had to wear a protective boot.
Now, doctors have diagnosed Menino with dehiscence ptosis, which means the tendon in the upper eyelid has become loose or detached, causing the lid to sag.
The normal position of the upper eyelid is 2 millimeters above the pupil. In Menino’s case, the lid droops down into the middle of the pupil. Iwamoto said doctors ruled out any underlying neurological problem and determined that the cause was likely age.
“His ptosis occurred over a long period of time. It was very gradual,” Iwamoto said. “It can creep up on people. It’s not like a sudden thing.”
To compensate for low-hanging eyelids, people often unconsciously raise their eyebrows or tip their head back to help their vision. Iwamoto will make an incision in Menino’s eyelid. The tendon will be cut, shortened, and reattached to the bottom of the eyelid.
In 10 to 15 percent of cases, the eyelid can change position after surgery, which necessitates a follow-up procedure, Iwamoto said.
The surgery is expected to help the mayor see better and change his appearance because his eyes will open wider. But Iwamoto said the procedure is not a face lift or elective cosmetic surgery.
“The need for a correction is definitely driven by a medical need, not aesthetics,” Iwamoto said. “This is functional.”