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The Impact of ptosis on a Child's Development and Vision

Congenital ptosis refers to a droopy eyelid in a child that is present at birth or develops within the first year of life. It typically does not indicate any other underlying medical issues. However, if an eyelid droops over a period of days or weeks, urgent assessment is required to exclude any serious neurological causes. The majority of congenital ptosis cases that occur in children are not inherited, although some rare cases may be. Read more about ptosis

When a parent notices a droopy eyelid or ptosis in their child, it can be a cause of concern. The most common cause of ptosis in children is a weakened levator palpebrae superioris muscle (or the levator muscle for short) which lifts the eyelid. The muscle may be weak due to incomplete development. Occasionally, congenital ptosis may also be associated with a reduction in the upward gaze of the eyes known as double levator palsy. This occurs as the muscle that lifts the eyelid is closely related to the muscle that moves the eyelids upwards, the superior rectus muscle. While rare, other causes of ptosis may also exist.

  • Trauma from birth with use of forceps

  • Disorders with the eye movements

  • Marcus Gunn Jaw Winking

  • Nervous system disorders

  • Blepharophimosis syndrome

  • Kearns-Sayre syndrome

  • Eyelid tumours or growths.


Is congenital ptosis permanent?

A droopy eyelid, also known as ptosis, is caused by a weakened levator muscle which lifts the eyelid. The muscle does not develop properly and will not strengthen over time without intervention. If left untreated, the ptosis will persist, and the eyelid will continue to droop.

Does the ptosis get worse with age?

Congenital ptosis typically remains stable and does not deteriorate with age. Conversely, age-related ptosis is a distinct condition that affects adults and may become worse over time if left uncorrected.

What is congenital Horners syndrome?

Horner’s syndrome is a rare condition characterized by a partial droop of the upper eyelid, a constricted pupil, and a lack of sweating due to disruption of the sympathetic nerve supply. Congenital cases may lead to a lighter color of the iris on the affected side.

Can congenital ptosis correct without surgery?

Congenital ptosis cannot be corrected on its own nor does medication cure it. Surgery is essential to lift the drooping eyelid as it does not show any improvement on its own.

How is ptosis corrected in babies?

Eyelid lift surgery is necessary to correct ptosis, and the approach used may vary based on the underlying cause.

  • If ptosis is not causing vision obstruction, it can be postponed until the child is around 3 or 4 years old when they have grown. The surgery is generally performed during childhood, so that the child can attend school without confidence issues or the fear of it becoming a reason for bullying.
  • If ptosis is obstructing vision, surgery is immediately recommended to prevent amblyopia or “lazy eye,” where the vision does not develop fully in the affected eye.

How can congenital ptosis be fixed?

A number of procedures can be used to fix congenital ptosis. They include:

  • Levator resection with a skin crease approach
  • Levator and Mueller’s muscle resection via a conjunctival approach
  • Fasanella-Servat procedure
  • Anterior approach eyebrow suspension (frontal sling)
  • Posterior approach frontal sling
  • Frontalis flap

The procedure used to address the residual function of the levator muscle is determined based on the child’s condition and after discussing the benefits and risks of each option with the parents. All of these procedures are conducted with the child under general anesthesia.



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