Pediatric Ophthalmology Consultants

What is Ptosis?

Ptosis is a drooping of the upper eyelid. The lid may droop only slightly, or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision. It can be present in children, as well as adults, and may be treated with surgery.

Ptosis can affect one or both eyelids, be inherited, be present at birth, and occur later in life.

Ptosis that is present at birth is called congenital ptosis. If a child is born with moderate to severe ptosis, treatment may be necessary to allow for normal vision development.

Ptosis in children

Congenital ptosis is often caused by poor development of the muscle that lifts the eyelid, called the levator. Although it is usually an isolated problem, a child born with ptosis may also have eye movement abnormalities, muscular diseases, lid tumors or other tumors, neurological disorders, refractive errors. Congenital ptosis usually does not improve with time.

What are the signs and symptoms?

The most obvious sign of ptosis in children is the drooping lid itself. In congenital ptosis, there is often asymmetry of the upper eyelid creases. Children with ptosis often tip their heads back into a chin-up position to see underneath their eyelids, or they may raise their eyebrows in an attempt to lift up the lids. These head and facial maneuvers are good signs that the child is trying to use both eyes to see. Over many years, abnormal head positions may cause deformities in the head and neck.

What problems can result from ptosis in children?

The most serious problem associated with childhood ptosis is amblyopia (lazy eye). Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. This can occur if the lid is drooping severely enough to block the child’s vision. More frequently it can occur because ptosis tends to change the optics of the eye, causing astigmatism and constant blurring of the visual image. Finally, ptosis can hide misaligned or crossed eyes, which can also cause amblyopia. If amblyopia is not treated early in childhood, it persists throughout life and may lead to permanent vision loss.

How is congenital ptosis treated?

In most cases, the treatment for childhood ptosis is surgery. If amblyopia is present, treatment with patching, glasses and/or eye drops may also be necessary. In determining whether or not surgery is necessary and what procedure is the most appropriate, an ophthalmologist must consider a few important factors such as the child’s age, whether one or both eyelids are involved, measurement of the eyelid height, eyelid’s lifting and closing muscle strength, observation of the eye’s movements.

During surgery, the levator, or eyelid lifting muscles, are tightened. In severe ptosis, when the levator is extremely weak, the lid can be attached or suspended from under the eyebrow so that the forehead muscles can do the lifting.

Mild or moderate ptosis usually does not require surgery early in life. Children with ptosis, whether they have had surgery or not, should be examined regularly by an ophthalmologist for amblyopia, refractive disorders, and associated conditions. Even after surgery, focusing problems can develop as the eyes grow and change shape.

What are the risks of ptosis surgery?

The risks of ptosis surgery include infection, bleeding and reduced vision, but these complications occur very infrequently. Immediately after surgery, you may find it difficult to completely close the eye, but this is only temporary. Lubricant drops and ointment can be helpful during this period.

Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation may be required.

American Academy of Ophthalmology
The Eye M.D Association


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