Childhood eyelid ptosis
What is childhood eyelid ptosis?
Eyelid ptosis is the drooping of the upper eyelid over the eye to varying degrees of severity. When it occurs before the age of eight, it is known as childhood eyelid ptosis.
As the child is in a period of visual development and growth, one of the specific consequences of not being able to open the eye normally can be the onset of amblyopia, or “lazy eye”.
The affected eye does not receive adequate visual stimuli and does not develop to its full potential.
What causes it?
The main causes are:
Strabismus: when the eyes are misaligned and point in different directions, the child’s brain, which has a great ability to adapt, suppresses vision in one eye to counter the abnormality and prevent double vision.
Refractive error: when a child has hyperopia, astigmatism or myopia, the image that reaches the brain lacks sharpness, resulting in the brain selecting the vision of the eye with less refractive error.
Cataracts, ptosis (drooping eyelid), retinal diseases: other diseases that interfere with the proper development of vision in children.
What cause it?
In adults, ptosis is usually acquired due to advanced age, trauma, muscle diseases or neurological disorders. In children, however, ptosis is usually congenital (present at birth) and related to poor eyelid muscle development.
Childhood ptosis is not usually associated with family history or any other disease. It is usually a consequence of damage during the embryonic development of the eyelid’s levator muscle, which, despite being well connected to the eyelid, lacks the strength to elevate it.
Other less common causes exist, such as allergic reactions, muscle diseases (Steinert), neurological disorders (progressive supranuclear palsy, Horner’s syndrome, myasthenia gravis) and local trauma.
In some exceptional cases, in which onset is rapid, within days or weeks, an eye examination and imaging tests are necessary to detect for serious conditions, such as aneurysms or intracranial tumours.
As the drooping of the child’s upper eyelid is clearly visible, ptosis is easily detected. If the condition is congenital, however, with the baby suffering from mild ptosis, it may be difficult to notice any visual impairment for a number of years, by which time the condition may have become more serious. It is important to be attentive during the first years of the baby’s life.
If infants appear to have difficulty keeping their eyes open while they read, write or draw, a specialist should be consulted.
Other symptoms of childhood ptosis include:
- Raising the eyebrows and eyelids
- Tilting the head back to see better
- Lifting the eyelid with a finger
The treatment for ptosis is surgery. The aim of surgery is to repair the tendon that lifts the eyelid or enable the muscle to recover its usual tone.
IMO currently performs eight different techniques – some of which are ground-breaking in the field –, depending on the characteristics of each case.
Ptosis surgery is not usually performed on patients under the age of five. The reasons for this are that infants usually refuse to cooperate during the pre-operative assessment process, the anatomical structures to be treated are still in the early stages of development and post-operative recovery is too traumatic for small children to endure. The only exception is when there is a risk of amblyopia due to pupillary occlusion or torticollis, in which case the eyelid must be corrected immediately.
In cases of trauma or allergy-related ptosis, patients are advised to wait a few months for the ptosis to subside by itself.
- Ptosis surgery
What is lazy eye (amblyopia)?
The amblyopic eye has not developed vision correctly, but all eye structures are in good condition. Vision develops from birth, and the eye becomes increasingly more capable of perceiving objects, which is called visual acuity. The amblyopic eye does not develop visual acuity for various reasons. The eye is anatomically correct, i.e. its structures are normal, but vision has not developed.