Can children have drooping eyelids?
Ptosis or drooping eyelid can be found in both children and adults with different causes and different impacts.
In children, from birth to 7-9 years old, is a period of visual development. If the drooping eyelid is severe enough to block vision, it can reduce visual development, leading to amblyopia (lazy eye). This is the key difference between ptosis in children compared to ptosis in adults.
Common causes
- Congenital ptosis: This is the most common group and can affect one or both eyes. In this group, besides drooping eyelids, there is no eyelid crease or no double eyelid.
- Neuromuscular transmission disorder (Myasthenia gravis): The drooping eyelid in this group changes over time. For example, eyelids often droop in the afternoon after prolonged eye use, and improve after rest or sleep.
- Ptosis due to third cranial nerve palsy (Oculomotor nerve palsy): Rare in children, often accompanied by abnormal eye muscle movement or strabismus, and may involve other neurological abnormalities.
- Ptosis due to aberrant nerve control (Aberrant Jaw-winking ptosis): This group often has abnormal muscle movements related to the eyelid, such as improvement of ptosis when the child is sucking, which is an uncommon condition.
Symptoms
Besides visible drooping eyelids, some cases, especially bilateral ptosis, show a chin-up position to allow the eyes to look downward to avoid the drooping eyelids and enable vision. In some cases, the drooping eyelid presses on the cornea causing astigmatism. Additionally, it can affect personality, making the child appear sleepy all the time.
Treatment
The first step is to identify the cause of ptosis, especially ptosis caused by neuromuscular disorders (Myasthenia gravis), as this type can often be controlled with oral medication. Then, the impact of ptosis such as amblyopia and astigmatism should be assessed and treated simultaneously, including wearing glasses and patching the good eye to stimulate the lazy eye. Surgery to lift the eyelid is then performed, with various techniques depending on the severity of ptosis and the child’s age.
The appropriate age for surgery is from 4 years old and above, and surgery can be repeated if ptosis recurs in the future.
Dr. Warakorn Thiamthat
Ophthalmologist, Eye Center
Phyathai 2 Hospital
