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Congenital ptosis - droopy eyelids in babies and children

A droopy eyelid in a child that presents at birth or in the first year of life is known as congenital ptosis. It is usually not associated with any other medical problems. If an eyelid drops over a period of days or weeks then an urgent assessment is needed to exclude any serious neurological cause. The majority of congenital ptosis that occurs in children is not inherited although few are.

Why does my baby have a droopy eyelid?

Noticing a poppy eyelid or ptosis in a child can be concerning to a parent. The most common cause is a weakness of the muscle that lifts the eyelid. This muscle is called the levator palebrae superioris (or just the levator for short). The muscle is weak because it has not fully developed. Sometimes a congenital ptosis is associated with a reduction in the eyes looking upwards. This is known as a double levator palsy. It occurs because the levator muscle that lifts the eyelid is closely associated with the muscle that moves the eyelids upwards. The muscle that lifts the eyeball upwards is called the superior rectus muscle. Other rare causes of ptosis include:

  • 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?

The droopy eyelid is caused by a weakness in the levator muscle that lifts the eyelid. It does not develop properly and will not develop on its own with time. If left untreated the ptosis will remain and the drooping of the eyelid will persist.

Does the ptosis get worse with age?

Congenital ptosis tends to be stable and not worsen with age. Age related ptosis is a different condition that affects adults and can progress with time if it is left uncorrected.

What is congenital Horners syndrome?

Horner syndrome is rare. It is a condition that can present with a mild upper eyelid droop a constricted pupil and absence of sweating due to disruption in the nerves affecting the sympathetic nerve supply. In congenital cases the iris colour can be affected with a lighter iris colour on the affected side.

Can congenital ptosis correct without surgery?

Congenital ptosis does not correct on its own and there is no medication that can cure it. It does not get better without surgery to lift the eyelid.

How is ptosis corrected in babies?

Ptosis is corrected with eyelid lift surgery. There are different approaches depending on the cause.

  • If the ptosis is not blocking the vision, surgery can be delayed until the age of 3 or 4 when the baby has grown. It is usually done in childhood so that they can go to school and not have it affect their confidence or to avoid it becoming a cause of bullying.

  • If the ptosis blocks the vision, surgery is done straight away to prevent amblyopia. Amblyopia is sometimes known as a lazy eye where the vision does not fully develop in the eye with ptosis.

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 resection by a conjunctival approach

  • Fasanella-Servat procedure

  • Anterior approach eyebrow suspension (frontal sling)

  • Posterior approach frontal sling (see picture)

  • Frontalis flap

All of these procedures are performed under a general anaesthetic. The procedure used depends on the amount of residual function of the levator muscle, a discussion with the parents on the benefits and risks of each option and what is most appropriate for the child.

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