Congenital Ptosis Surgery

Congenital Ptosis Surgery

What is congenital ptosis?

Congenital ptosis refers to a droop of the upper eyelid that is present since birth. This is due to an abnormal development of the levator muscle that is responsible for lifting the eyelid. It is often unilateral but can be bilateral and may be associated with other abnormalities.

Does my child require surgery? If so, when is a good time to undergo surgery?

In mild cases where vision is not affected, there is no urgency to undergo surgical repair. It may be good to wait till the child is old enough to tolerate surgery under mild sedation only so as to achieve optimal outcomes with just one surgery. However, it is best to see an eye doctor to determine if there is any risk of amblyopia or lazy eye before making the decision to hold on to treatment.
Surgery is indicated when the ptosis is severe enough to obstruct vision either fully or partially. In these cases, it is best to perform surgery early to avoid amblyopia or lazy eye. Surgery also allows the correction of the abnormal chin-lift posture that the ptotic child adopts to see better.
There are different surgical techniques available and the choice depends on the strength of the levator muscle as well as the surgeon preference.

What post-operative care do I need to be aware of before we decide to proceed?

There are two major issues that parents and the older patient must be aware of when consenting to congenital ptosis repair. As the muscle involved is abnormal, the upper eyelid will be at a higher level in downgaze following surgery. The child will also be unable to close his or her eye fully, especially during sleep. There are ways to manage these downsides including the regular use of tear gel medications prior to sleep. It is good to know that the improvement in symmetry in straight gaze usually more than makes up for these inconveniences.