Introduction

Ptosis is the medical name given to the condition in which one or both the eyelids become droopy. If this condition is present in children at the time of birth or is acquired within the first year of the childhood, then this condition is known as congenital ptosis. Congenital ptosis is one of the most common eye abnormalities that are found in babies. Though the exact reason behind congenital ptosis is not known, some doctors believe that it may be found in some babies due to their position in the mother’s uterus. Most of the cases of minor congenital ptosis get corrected by themselves within the first few years; however more severe case may require surgical intervention.

Congenital ptosis can be present in either one or both the eyes. The droopiness may cause the vision to be partially or completely obstructed. Persistent congenital ptosis should be surgically treated otherwise it may lead to amblyopia which is a disorder of vision. This may cause the vision to be constantly blurred.

Cause of congenital ptosis

 A muscle which is called levator muscle enables us to lift our eyelids. Due to improper development of levator muscles, the upper lid falls down as it is inadequately supported. Generally the case of congenital ptosis is considered to be idiopathic in nature therefore nobody can say for sure as to why it happens. However, in babies where it is present in both the eyelids the congenital ptosis can be genetic. N very rare cases, some babies may be affected by specific type of ptosis which is called “Marcus Gunn jaw wink”. This type of ptosis does not require any surgery. In this ptosis there is a mild droop in the upper eyelid which moves up and down as the baby eats or drinks. Though congenital ptosis is often an isolated problem but if it is present in both eyes it could be sign of a bigger underlying problem. Therefore the baby might have to undergo a series of tests to rule out the possibility of any other congenital disease.

What are the treatment options available for congenital ptosis?

In most cases of mild to moderate congenital ptosis surgical intervention is not required. But, if parents or guardians of a baby want to get a corrective surgery for the baby, it is preferred that the child is at least 3 years or older in age. Though, mostly all cases of congenital ptosis are not very likely to get worse.

If the extent of droopiness is high, the baby might need to undergo corrective surgery in order to have normal vision development. In the surgery, the levator muscle slack is corrected so it gets tightened. If the levator muscle is very loose, the upper eyelids muscles may be reattached just under the eyebrow so that the weight of the eyelids can be carried by the muscles in the forehead. If the congenital ptosis has caused astigmatism or amblyopia it may have to be treated after the surgery for congenital ptosis. The corrective measures may include covering the stronger eye to encourage the weaker eye to exert more so that it eventually becomes stronger. To correct astigmatism the child may have to wear corrective glasses. The child will have to undergo regular eye tests to ensure that the vision is developing normally and no post- surgical complications are present.

What are factors considered by the surgeon before surgery for congenital ptosis?

Before making the decision about whether or not the child requires surgery and if he does what approach would be the best, there are certain factors that every ophthalmologist would consider. They are:-

  • The age of the child. Most ophthalmic surgeons recommend the child be of at least 3 years of age for the congenital ptosis to be completely surgically corrected.
  • The height of the eyelids.
  • The strength of the levator muscles which closes and opens the eyelids.
  • The movements of the child’s eyes.

There are some tell tale signs that may indicate that the child is having problems with his vision and every parent should immediately visit a pediatric ophthalmologist if any of the signs are present. In babies, if the creases of the upper eyelids look asymmetrical, it may be an indication of congenital ptosis. If the child seems to keep his chin high while reading, watching TV or in other routine activities it may mean that he is facing problem and that his vision is obstructed. Children with ptosis try to move their eyebrows upwards to try and lift their eyelids.

After the surgery for congenital ptosis, the child may experience temporary discomfort and find it difficult to close his eyes completely. This is a temporary problem. In rare cases, additional corrective surgery may be required as the eyelids may not appear symmetrical.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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