Congenital Ptosis
Ptosis is the medical term for drooping of the upper eyelid, which may affect one or both eyes. When ptosis is present at birth it is called “congenital” ptosis. When the condition is moderately severe, the lid partially covers the pupil. In an effort to see from under their drooping eyelids, children with moderate to severe cases tilt their head back into a chin-up position and then use their fingers to lift their eyelid or raise their eyebrow in order to see.
CAUSES OF CONGENITAL PTOSIS
While the cause of congenital ptosis is often unclear, the most common reason is abnormal development of the major muscle (levator) responsible for elevating the upper eyelid.
ASSOCIATED PROBLEMS
Children with congenital ptosis may also have "amblyopia" (lazy eye), strabismus (eyes that are not properly aligned or straight), refractive errors, astigmatism or blurred vision. In addition, drooping of the upper eyelid may result in an undesired facial appearance.
TREATMENT OF CONGENITAL PTOSIS
Congenital ptosis is treated surgically. The specific surgery is based on the severity of the ptosis and the strength of the levator muscle. General anesthesia is used during the surgery. If the ptosis is not severe, surgery is generally performed when a child is between three (3) and five (5) years of age (the “pre-school” years). Ptosis surgery usually involves tightening the levator muscle to elevate the eyelid to the desired position. In severe ptosis, the levator muscle is extremely weak and a “sling” procedure may be performed. This procedure enables the forehead muscles to elevate the eyelid(s).
The main goals of ptosis surgery are (1) elevation of the upper eyelid to permit normal visual development, (2) full field of vision and (3) symmetry with opposite upper eyelid. It is important to realize that when you operate on abnormal muscles, completely normal eyelid position and function after surgery may not be possible to achieve. Children with congenital ptosis should be followed closely before and after surgery by their eye doctor to ensure that the child's vision is developing properly.