Ptosis refers to a droopy eyelid. Congenital ptosis is a droopy eyelid that is present from birth. There are many causes of ptosis. If the ptosis was not present at birth, it is very important for your doctor to determine the cause of the condition.
Ptosis can involve one or both eyelids. If the eyelids droop enough to cover the pupil, the child may not develop vision normally causing amblyopia. It is very important for any child who has a droopy eyelid to be seen by a pediatric ophthalmologist to determine if the child is developing vision normally. In addition, children with ptosis may have astigmatism that can also affect visual development.
Treatment of ptosis is determined by 2 factors: How the child’s vision is developing and the child’s head position. A child may have an abnormal head position if they are holding their head in a position (often tipping their head back) to help them see. If only one eyelid is droopy, your doctor may have the child wear an eye patch the good eye to help develop vision from the eye with the droopy eyelid.
If a child is not developing vision normally or developing an abnormal head position, surgery may be recommended. There are essentially three types of surgery used to treat congenital ptosis. The surgery performed depends on the amount of droopiness and the strength of the muscle that lifts the eyelid. There are many factors to take into consideration in deciding the appropriate surgery to recommend for a child with a droopy eyelid.
If a child has a droopy lid but is developing vision normally and does not have an abnormal head position, surgery is often delayed until the age of 4 or 5 years, so that it is done before the child starts school.
After surgery, it is common for a child to have a slightly open eye while sleeping. Although alarming to the parents, this usually improves with time. Lubricating eye drops or ointments can be used during this time to prevent dry eye.