Ptosis is a drooping of the upper lid of one or both eyes. It can be mild, where the lid partially covers the pupil, or severe where the lid completely covers the pupil. In children, ptosis is usually congenital. The most common cause of ptosis is improper development of the major muscle responsible for lifting the upper eyelid.
Children with ptosis will often raise their eyebrows to raise the eyelid and may also hold the head back to see out from under the eyelid. This allows them to see normally, despite the droopy lid.
We take a conservative approach to treatment in pediatric ptosis. We wait until the child has reached the age of 3-1/2 to 5 years old before considering surgically correcting ptosis. By this age, the eyelid structures are more developed, which gives us a much better result. However, if the ptosis interferes with the child’s vision, surgery may be performed earlier to allow for proper visual development.
To correct ptosis, we raise the dropping lid to match the level of the other lid. We also match the curve of the drooping lid to the curve of the other eye. If both eyes have ptosis, then we correct both eyes. This is done as an outpatient procedure, under general anesthesia, and the child goes home the same day.
After surgery, an eye pad is usually used for 24-48 hours, and ointment or antibiotic drops are prescribed for 1-3 weeks. The upper eyelid will usually appear swollen for the first 7-10 days.