Ptosis in Children

Ptosis (pronounced to’sis) simply means droopy eyelid. It is one of the most common eyelid problems. The lid may droop slightly, or cover the entire pupil. Ptosis can restrict and even block normal vision. It can be present in children and adults, and is usually treated with surgery.

When ptosis is present at birth, it is called “congenital ptosis.” For moderate to severe cases, treatment is necessary to allow for normal vision development. If congenital ptosis is not corrected, amblyopia (lazy eye) may develop, which, if left untreated, can lead to permanent loss of vision.

Congenital ptosis is often caused by poor development of the levator muscle (the muscle that lifts the eyelid). It is usually an isolated problem, but may also be associated with eyelid tumors, muscular diseases, strabismus (eye movement abnormalities), neurological disease, or refractive error (need for eyeglasses).

Congenital ptosis is treated differently depending on severity and the strength of the levator muscle. If the ptosis is severe, the levator muscle is tightened when the levator muscle’s strength is fair to good. When the levator muscle is extremely weak, the eyelid can be suspended from under the eyebrow (frontalis suspension) so that the forehead lifting muscles can do the lifting. If the ptosis is mild to moderate, surgery is usually not needed early in life, and may be delayed until the child is older.

Ideally, ptosis correction is best performed with the patient awake with mild sedation and local anesthesia (monitored anesthesia care), as apposed to being asleep (general anesthesia). This is because real-time adjustments can be made after asking the patient to open his eyes and assessing the eyelid height. Otherwise, post-operative adjustments require another trip to the operating room. If the ptosis is mild enough, delaying surgery until the patient is old enough to have it under monitored anesthesia care is often recommended.