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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 is usually treated with surgery.
Ptosis can:
Ptosis which is present at birth is called congenital ptosis. If a
child is born with moderate to severe ptosis, treatment is necessary
to allow for normal vision development. If it is not corrected, a
condition called amblyopia (lazy eye) may develop. If left untreated,
amblyopia can lead to permanent vision loss.
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 have:
Eye
movement abnormalities;
Muscular diseases;
Eyelid tumors;
Neurological disorders;
Refractive errors.
Congenital ptosis does not generally improve with time.
What are the signs and symptoms?
The
most obvious sign of ptosis in children is the drooping lid itself.
Children with ptosis often tip their heads back into a ãchin-upä
position to see out from underneath their eyelids. In addition the
may raise their eyebrows in an attempt to lift up the lids. 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, or
a ãlazy eyeä. 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 childâsâ vision. More
frequently, it can occur because ptosis can change the optics of the
eye, causing astigmatism. Finally, ptosis can hide misaligned or
crossed eyes, which can cause amblyopia.
If
amblyopia is not treated early in childhood, the vision loss can
persist for life.
How is congenital ptosis treated?
In
most cases, the treatment for childhood ptosis is surgery, although
there are a few rare disorders which can be corrected with
medications. In determining whether or not surgery is necessary and
what procedure is the most appropriate, an ophthalmologist must
consider a few important factors:
The childâs age;
Whether one or both eyelids are involved;
Measurement of eyelid height;
The eyelidâs lifting and closing muscle strength;
Observation of the eyeâs movements.
During surgery, the levator muscle 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 annually by an ophthalmologist for amblyopia, refractive
disorders and associated conditions. Even after surgery, focusing
problems can develop as the eyes grow and change shape.
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