Ptosis (Ptosis or drooping eyelid) is a condition that can be found in both children and adults, with different causes and impacts. In children, from birth to 7-9 years old, it is a critical period for visual development. If the drooping eyelid obstructs vision significantly, it can reduce visual development and lead to amblyopia.
Common causes of ptosis
- Abnormality in eyelid formation from birth (Congenital ptosis) is the most common group. It 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 characteristic of ptosis in this group changes over time. For example, the eyelids often droop in the afternoon after prolonged eye use, and improve after resting or sleeping.
- Ptosis due to third cranial nerve palsy (Oculomotor nerve palsy) is uncommon in children. It is often accompanied by abnormal eye muscle movement or strabismus, and may also involve other neurological abnormalities.
- Ptosis due to aberrant nerve control (Aberrant Jaw-winking ptosis) In this group, there is often abnormal movement of related muscles, such as ptosis improving when the child sucks milk, which is a rare condition.
Warning signs of ptosis
Besides visible drooping eyelids, some cases, especially bilateral ptosis, show a chin-up position to allow the eyes to look downward and avoid the drooping eyelids, helping to improve vision. In some cases, the drooping eyelid presses on the cornea causing astigmatism. Additionally, it affects appearance, making the child look sleepy all the time.
Treatment of ptosis
The first step is to identify the cause of ptosis, especially ptosis caused by neuromuscular transmission disorders (Myasthenia gravis), which can mostly be controlled with oral medication. Then, assess the impact of ptosis, such as amblyopia and astigmatism. If found, treatment should be done concurrently, including wearing glasses and patching the good eye to stimulate the amblyopic 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.
Postoperative care
- Use all prescribed eye drops. Some cases may require warm dry compresses to reduce swelling.
- Frequently use artificial tears to prevent dry eyes, which are common.
- Avoid getting the eye wet for 2 weeks.
Possible risks after surgery
- Swelling and bleeding, which can be managed by tightly closing the wound, applying cold compresses for the first 24 hours, followed by warm compresses.
- Recurrent ptosis, which can be treated with repeat surgery.
Why should ptosis be surgically treated?
- To prevent amblyopia if left untreated.
- To improve appearance.
