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Ptosis or drooping eyelid

  • How you say it: 'toe-sis'

    Ptosis is a drooping of the upper eyelid. The lid may droop only slightly, or it may cover the pupil or eye entirely. In some cases, ptosis can restrict and even block normal vision. It is usually treated with surgery. Ptosis can:

    • Affect one or both eyelids
    • Be inherited
    • Be present at birth
    • Occur later in life.

    Causes

    Ptosis is also known as 'drooping eyelid'. It is caused by weakness of the muscles responsible for raising the eyelid, damage to the nerves which control those muscles, or loose skin of the upper eyelids.

    In the more serious cases of ptosis, the lids may droop or sag so much that they actually block a person's vision.

    Ptosis or drooping eyelid can be caused by a congenital abnormality (present before birth), or an injury or disease. 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. Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. If left untreated, amblyopia can lead to poor vision permanently.

    Although it is usually an isolated problem, a child born with ptosis may also have:

    • Eye movement abnormalities
    • Muscular diseases
    • Eyelid tumors
    • Neurological disorders
    • Refractive errors.

    Congenital ptosis usually does not improve with time.

    Symptoms

    The most obvious sign of ptosis in children is the drooping lid itself. Children with ptosis often tip their heads back into a chin-up position to see underneath their eyelids, or they 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.

    • Drooping of both or one eyelid
    • Increased tearing (watery eye/s)
    • If ptosis is severe, interference with vision.

    Treatment

    In most cases, the treatment for childhood ptosis is surgery, although there are a few rare disorders which can be corrected with medications. The eye doctor (opthamologist) will assess your child and determine whether or not an operation (surgery) is needed, based on:

    • Your child's age
    • Whether one or both eyelids are involved
    • Measurement of the eyelid height
    • The eyelid's lifting and closing muscle strength
    • Observation of the eye's movements.

    During surgery, the levators (muscles which lift the eyelid), 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. Lubricant drops and ointment can be helpful during this period.

    Surgical repair is usually very successful in restoring the appearance and function of the eyelid, although the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation may be required.

    Key points to remember

    • If a drooping eyelid is left uncorrected in a child, it can lead to amblyopia ('lazy' eye).
    • The most serious problem associated with childhood ptosis is amblyopia, which can occur if the lid is drooping severely enough to block the child's vision. If amblyopia is not treated early in childhood, it persists throughout life.
    • Ptosis can be treated with surgery to improve vision as well as cosmetic appearance.
    • It is very important that children with ptosis have regular ophthalmic examinations early in life to protect them from the serious consequences of untreated amblyopia.

    For more information

    Developed by the RCH Dept of Quality and Improvement and Dept of Opthalmology. First published in August 2008.

Disclaimer
This is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. The Royal Children's Hospital accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.
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