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Ptosis (blepharoptosis), more commonly known as droopy eyelids, is a condition where one or both upper eyelids droop lower than they should, possibly causing obstruction of sight. Ptosis that occurs at birth or within your child’s first year is called congenital ptosis. Congenital ptosis may be treated with ptosis correction surgery.
Simple congenital ptosis is the most common form that occurs in 1 in 842 births, and the left side is more likely to be affected. [1]
Usually, ptosis occurs with old age because of weakened muscles and sagging skin. In infants and children, childhood or congenital ptosis is often due to neurological issues that affect the nerves or levator muscles of the eye. These include:
It may also be caused by an eyelid mass or accidental stretching or tearing of the levator muscle. If ptosis occurs suddenly, it may be indicative of a more urgent medical issue and immediate medical attention may be necessary.
If the ptosis is not severe, the only complication would be that your child’s eyelid creases do not line up evenly with each other and it may not look aesthetically pleasing. However, for more serious cases, your child’s droopy eyelid may cause severe vision issues and give rise to other complications such as [2]:
They may develop amblyopia or developmental delay because their eyelids limit their vision.
They can also have astigmatism, where their vision is blurred.
They can have misaligned eyes.
It is important to treat your child’s ptosis to prevent complications and to preserve your child’s vision development.
If time permits, we suggest that you wait until your child is older before undergoing ptosis correction surgery. This ensures better patient compliance and allows the surgeon to make more accurate pre-operative measurements, as your child’s facial features would have grown and matured. Moreover, post-operative recovery may be too distressing for young children to experience.
Personally, we would recommend that your child be at least twelve years old before undergoing ptosis correction. An exception would be if it interferes with normal visual development, in which case the blepharoptosis should be corrected early.
Ultimately, the treatment of your child’s ptosis is dependent on its cause. If your child has ptosis due to other underlying medical issues, your doctor will treat the issue first. For example, if a tumour is causing your child’s ptosis, the doctor may remove it.
For temporary ptosis, a special intervention, known as Ptosis Crutches, can be prescribed to hold the eyelids up and are attached to the frame of your child’s glasses.
In moderate to severe cases, ptosis correction surgery is advised.
The doctor will first conduct a detailed examination of your eyes and facial anatomy before deciding on what changes will be made and addressing any concerns you may have. The doctor will take note of the marginal reflex distance - which is the distance from your pupil’s centre to the upper eyelid - to determine whether ptosis correction is needed.
Local anaesthesia will be administered to ensure that your child is comfortable. After which, the treatment entails tightening or shortening the tendon of the eyelid opening muscle. It is an outpatient procedure and lasts about 30-60 minutes.
The upper eyelid anatomy is delicate and complex, therefore it is paramount to consult a specialist surgeon to ensure an optimal outcome.
Generally, your child will experience minor swelling and bruising around the eyes which will disappear within a few days. If proper post-surgery care procedures are followed, there should be no visible scarring.
Ptosis correction surgery is definitely a procedure to consider for your child when they are older and if they suffer from moderate to severe ptosis. After surgery, It is important for your child to practice proper post-surgery care to prevent complications and to ensure optimal results. Moreover, Ptosis correction may help to improve your child’s self-confidence later in life. Always remember to communicate both your desires and concerns with a trusted plastic surgeon so that they may assist you in your decision.
