Ptosis in Children

What is ptosis?

Ptosis is drooping of the upper eyelid. The lid may droop slightly or it may cover the pupil and block vision. (The pupil is the dark center of the eye.) It may happen to one or both eyelids.

Ptosis that is present at birth is called congenital ptosis. It can cause permanent vision loss in a child because their vision may not develop properly. One of their eyes may become lazy (amblyopia). The eyelid does not have to cover the pupil completely for this to happen. Sometimes the eyelid presses on the eye, changing the shape of the cornea. (The cornea is the clear outer layer on the front of the eye.) An unevenly shaped cornea can cause blurred or distorted vision (astigmatism).

How does it occur?

Congenital ptosis occurs when the muscle that lifts the eyelid is poorly formed. The eyelid muscle is called the levator muscle.

Sometimes swelling of the eyelids, or certain types of growths around the eyelids, can cause drooping. Some kinds of nerve or muscle problems can cause ptosis as well.

What are the symptoms?

The drooping eyelid is the main symptom of ptosis. Some children will hold their head back so that the eyelid does not get in their way of seeing.

How is it diagnosed?

Your eye care provider will examine your child to see if the vision is developing normally in each eye. He or she may ask your child to look up and down to see how much the eyelid moves with the eye. In congenital ptosis, the eyelid moves poorly with eye movement.

How is it treated?

If drooping eyelids are not causing any vision problems, often nothing has to be done. If there are problems with vision or appearance, surgery can be done to attach a sling from the eyelid to the muscle that lifts the eyebrow, or the levator muscle may be tightened.

Your healthcare provider will want to see your child regularly to check that his or her vision is developing normally. If the vision is developing unevenly, using a patch or special eyedrops in the good eye may be necessary. This will help the less used eye develop.

How long will the effects last?

Congenital ptosis does not get better without surgery. Surgery is usually successful, but it can be hard to know whether the eyelid height will be exactly the same for both eyes after surgery. Usually children need more than one surgery to fix congenital ptosis as they get older.