IOP Inc. - What Is Congenital Ptosis? What Are The Early Signs?

Home » Patient Link » Ptosis

Congenital Eyelid Ptosis

What Is Congenital Ptosis? What Are The Early Signs?

Ptosis is a medical term for drooping of the upper eyelids. Ptosis present at birth is called congenital ptosis. In mild cases of ptosis, the lid droops only slightly. In moderate to severe cases, the lid may partially or completely cover the pupil. This, of course, will affect the child's ability to view the world. In order to compensate for the abnormality, children with significant ptosis may tilt their head back into a chin-up position, prop their eyelid open with their fingers, and/or raise their eyebrows in an effort to view the world.

Prior to Surgery

Post Surgery

What Are The Causes Of Congenital Ptosis?

While the causes are often unclear, childhood ptosis is a result of an improper development or dystrophy of the levator muscle. This striated muscle is responsible for elevating the upper eyelid. This condition can affect one or both eyelids. Many experts believe the condition may be the result of hereditary factors. Other neuro-ophthalmologic causes of childhood ptosis include muscular diseases, eyelid tumors and neurological disorders.

Are There Other Problems Associated With Congenital Ptosis?

Yes, however these conditions are rare. Children with congenital ptosis may also develop amblyopia ("lazy eye"), strabismus (eyes that are not aligned and appear to wander), refractive errors, astigmatism or blurred vision. Cosmetically, ptosis may result in an undesirable facial appearance.

What Are The Treament Options?

If not repaired, this condition will remain unchanged throughout life. Your child should undergo a complete ophthalmologic examination. Your ophthalmologist will evaluate your child's vision and refractive error (need for glasses) and examine the pupils and the motility or movement of the eyes. Your doctor will measure the eyelid height and the eyelid's lifting and closing muscle strength. If the droop of the eyelid is severe enough to affect the child's vision, then early ptosis surgery may be indicated. If the child's vision is not affected, then the child will be closely monitored for changes in the condition.

Congenital ptosis is treated surgically with the specific operation being based on the amount of ptosis and the strength of the levator (lifting) muscle. If the ptosis is mild to moderate, surgery will usually be performed when your child is school-aged (3-5 years old). If the ptosis interferes with your child's vision, surgery will be performed at an earlier age to allow proper visual system development and to prevent or minimize amblyopia.

What Happens During Ptosis Surgery?

If affected muscle provides adequate strength, the surgery will involve the tightening of the levator muscle in order to elevate the eyelid to the desired position.

If the child's levator is extremely weak, a suspension or "sling" procedure will be performed by your ophthalmologist. Usually, small incisions are made above the eyebrows and at the eyelid margin. Through these incisions, a small strap of human tissue (fascia lata) or synthetic material is threaded to suspend the eyelid from the forehead muscle.

The strip is tightened to get the eyelid to the desired height. Each eyebrow incision is closed with suture. The eyelid incisions heal without sutures.

Both types of surgeries are performed under general anesthesia.

If The Surgeon Uses A Tissue Graft, Where Will It Come From?

If your surgeon recommends the use of human tissue, the type of tissue commonly used is fascia lata. Fascia lata is a type of tissue or collagen located in an area of the human body adjacent to the thigh muscle, known as the ilio-tibial tract. The surgeon may use a fascia lata autograft or a fascia lata allograft. An autograft is tissue (in this case, fascia lata) obtained from the patient's own body through what surgeons' refer to as a 'secondary surgical site'. An allograft is tissue obtained from a human donor.

Processed human fascia lata (allograft)

Experts believe both autografts and allografts have advantages and disadvantages. Autograft procedures can lengthen the time you are under anesthesia, result in greater discomfort and longer recovery period. With very young children, autografting may not be an option. The fascia lata in young children is not developed enough for autografting. Some people believe that allografts carry other risks: potential infectious disease transmission and higher rate of graft absorption.

The development of processed allografts (like Tutoplastâ) has diminished many of the allograft risks. Science has been able to identify agents and compounds capable of destroying viruses, antigens and pathogens. Tissue processing technology has also developed ways to increase the survivability of donor tissue grafts in the human body.

What Can We Expect Following Surgery?

The main goals of ptosis surgery are (i). the elevation of the upper eyelid to permit normal visual development and (ii) the creation of a full field of vision and symmetry with the opposite upper eyelid.

One day after surgery: Your child will be examined the day after surgery to assess vision, eyelid height and the incisions. You will be asked to keep the operative site clean and to place antibiotic ointment on the incisions several times per day.

One to two weeks after surgery: One to two weeks after surgery, your child will typically be re-evaluated. Once again, vision, eyelid height and the incisions will again be assessed.

Four to six weeks after surgery: It typically takes several weeks for the eyelid to reach its final or "settlement" height. If necessary, further adjustments can be made to improve eyelid placement. Many experts note that when operating on an abnormal muscle, completely normal, long-term eyelid position and function may not be possible to achieve.

Children with congenital ptosis should be followed closely by your ophthalmologist, both before and after surgery. This will help ensure that their vision is developing properly.