What Is Congenital Ptosis?


Ptosis is basically a condition where the upper eyelid is loosening due to some genetic issues. The eyelid might (or might not) drop significantly. If it does, the lid may actually engulf the entire pupil.


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 usually the cause of the upper eyelid elevation. This condition can affect one or both eyelids. Many experts believe it may be hereditary in some families. Other neuro-ophthalmologic causes of childhood ptosis include muscular diseases, eyelid tumors and neurological disorders.

Any Type Of Issues Associated With Congenital Ptosis?

Yes, however these conditions are rare. Children with congenital ptosis might develop amblyopia or strabismus or other similar conditions. Ptosis usually causes big concerns with self-esteem.

What Are The Treatment 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.

If you want to solve this condition, you might need to have some surgical treatment, although it all depends on the amount of ptosis and your levator 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 the affected muscle provides adequate strength, the surgery will involve the tightening of the eyelid to the ideal spot.

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 sutures. 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.

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 Tutoplast®) 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 ptosis surgery has the following objectives: to raise the upper part of the eyelid so the patient can have standard eyesight. Other than that, it’s seen as crucial for cosmetic reasons. 24 hours after surgery itself the patient will have to be re-analyzed to make sure everything is clean and done properly.

And just to be completely safe, the patient might need to use some antibiotic cream 3-4x each day. After a few weeks, the patient will be re-analyzed once again. People say it will not need more than seven weeks to completely achieve its final objective with the upper eyelid. While this condition might look annoying, there are multiple ways to solve this issue. Don’t worry too much about it.

If you want to read the clinical presentation of this condition, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338973/ has a very good resource for you to study.