Primary Care Liaison

Droopy eye lid ptosis

  • The following pre-referral guideline covers droop eye lid (ptosis). Please see other ophthalmology guidelines as appropriate.

    This guideline has not yet had a GP working group review.  We appreciate your  feedback.

    See resources for referral form, parent information and more.

    Recommended pre-referral assessment/treatment

    Please check the following:

    1. Assess ptosis - is the eyelid covering all of or any part of the pupil? (See diagram)
    2. Check visual acuity if child is of an appropriate age. If the child is too young to check visual acuity, ascertain whether the child can fix and follow - for toddlers, try a toy and for infants try a toy or a light.
    3. Check ocular motility - whilst holding the eyelids up ask the child to look at the ceiling, down at the floor and side-to-side. If child is too young, again try a toy or a light.
    4. Perform fundus examination and note presence/absence of red and white reflex.
    5. Assess pupillary reactions and sizes.

    Ptosis - pre-referral guideline OPHTHAL


    Findings and when to refer


    • If normal, re-assess in 2 months. 
    • If assessment results are abnormal or if ptosis persists past 2 months of age
      • Immediate Referral
        Fax to 03 9345 5034 and call 03 9345 6180 to note urgent referral.

    Older infant and child

    • Droopy eyelid obstructing vision (moderate to severe)
      • Immediate Referral
        Fax to 03 9345 5034, also call 03 9345 6180 to note urgent referral.
    • Sudden onset of droopy eyelid
      • Immediate Referral
        Fax to 03 9345 5034, also call 03 9345 6180 to note urgent referral.
    • Any child with a droopy eyelid that does not obstruct the pupil (mild)
      • Refer semi-urgently.
    • Older child (age 9 years +) with history of congenital droopy eyelid
      • Refer non-urgently for evaluation.

    Goto Top

    Contact information

    Clinical advice


    Opthalmology registrar or consultant on-call (via switch):

    (03) 9345 5522

    Department of Ophthalmology:

    (03) 9345 5630

    RCH Emergency Department

    (03) 9345 6477



    Booking enquiries 
    appointment rescheduling
     (Urgent bookings and for parents)

    Outpatient Referral form

    (03) 9345 6180 

    referral form

    Rural doctors only

    (03) 9345 6789 

    Admission enquiries


    General admission enquiries:

    (03) 9345 6172

    ED admission enquiries:

    (03) 9345 6477

    After hours / Switchboard:

    (03) 9345 5522



    Seriously unwell child: 

    (03) 9345 7007

    RCH Drug info-line:

    (03) 9345 5208



    References: Paediatric Handbook (2009). Eye Conditions, Chapter 23 (pp357-368). James Elder and Peter Barnett. 8th Ed, Blackwell Publishing by the Staff of the Royal Children's Hospital, Melbourne. Australia.

    Last updated

    Last update: August 2011

    Copyright and Disclaimer

    Goto Top