Congenital Ptosis (Drooping Eyelids in Children) Surgery Treatment …

Ptosis (Droopy Eyes / Droopy Eyelids) can affect one eye or both eyes. Ptosis may be present at birth, or may be acquired later in life. If a droopy eyelid/ droopy eyes are present at birth or within the first year of life, the condition is called congenital ptosis.


Congenital Ptosis

Droopy Right Eyelid in Child


Congenital Ptosis (Droopy Eyelids in Infants, Toddlers, Children) Etiology (Causes):

In most cases of congenital ptosis, the cause is idiopathic (unknown).

The eyelids are elevated by the contraction of the levator palpebrae superioris. In most cases of congenital ptosis, a droopy eyelid (droopy eyes) results from a localized myogenic dysgenesis. Rather than normal muscle fibers, fibrous and adipose tissues are present in the muscle belly, diminishing the ability of the levator to contract and relax. Therefore, the condition is commonly called congenital myogenic ptosis (Droopy eyelids causes by a defective eyelid muscle).

Congenital ptosis may occur through autosomal dominant inheritance. Common familial occurrences suggest that genetic or chromosomal defects are likely – Genetic causes are likely for their occurence.

Other rare potential causes of congenital blepharoptosis (droopy eyes in children) include:

•Blepharophimosis syndrome
•Third cranial nerve palsy (paralysis)
•Horner syndrome
•Marcus Gunn jaw-winking syndrome
•Birth trauma
•Duane syndrome
•Periorbital tumor
•Kearns-Sayre syndrome
•Myotonic dystrophy
•Myasthenia gravis

Congenital Ptosis (Drooping Eyelids in Infants, Toddlers, Children) Complications:

Amblyopia (lazy eye, in which vision does not develop normally) may result from obscuration of the vision directly or from development of astigmatism indirectly. Development of amblyopia is an indication for immediate surgical correction of the blepharoptosis.

•Occlusion amblyopia (Obstruction of light entering the eye causes a lazy eye and abnormal visual development)
•Astigmatism (visual refractive errors, requiring glasses for correction) from the compression of the droopy eyelid
•Ocular torticollis (Torsion of the neck, as the child turns the neck to see clearly)

Congenital Ptosis (Droopy Eyelids in Infants, Toddlers, Children) Management, Surgery & Treatment (Cure):

  • Not all patients with congenital ptosis need surgical intervention.
  • But, the children need to be closely monitored for the possible development of occlusion amblyopia (lazy eye occurring due to visual deprivation by the droopy eyelids). Since amblyopia may not be reversed after age 7-10 years, appropriate and timely medical and surgical treatment of congenital ptosis is critical to preserve the child’s vision.
  • Uncorrected congenital ptosis can result in amblyopia secondary to deprivation or uncorrected astigmatism.
  • An abnormal eyelid position can have negative psychosocial effects. Children can be very cosmetically and socially aware and if peers treat them differently because of their drooping eyelids, the ptosis may have huge lifetime lasting, confidence damaging psychological impact.
  • Uncorrected acquired blepharoptosis results in decreased field of vision (superior) and frontal headaches.

General treatment

Early consultation with an oculoplastic surgeon, trained in both ophthalmology and plastic surgery, to avoid amblyopia.
•Must be able to rule out and document other possible causes of ptosis (eg, Horner syndrome, third cranial nerve palsy), which may impact growth and other parts of the body’s development.

Medical therapy

Only observation is required in mild cases of congenital ptosis, if no complications like signs of amblyopia, strabismus, and abnormal head posture are present.

Ptosis Surgery (Eyelid Lift Surgery for Droopy Eyelids in Children, Toddlers & Infants) Treatment & Cure:

Congenital blepharoptosis has physical, functional, and psychological consequences.

  • The method of repair depends on treatment goals, the underlying diagnosis, and the degree of levator function. Although the primary reason for the repair is functional, the oculoplastic surgeon has an opportunity through this procedure to produce symmetry in lid height, contour, and eyelid crease for better cosmesis. A good eyelid surgeon understands that ptosis correction has to have a cosmetic (aesthetic) thought process – When a child looks at the world, the world looks at their eyes – And, so, the eyes must look the same (symmetrical eyelid heights) and beautiful, post surgery.
  • Surgical correction of congenital ptosis can be undertaken at any age depending on the severity of the disease. Earlier intervention may be required if significant amblyopia or ocular torticollis is present.

Types of Eye lift / Eyelid Lift Surgery for Congenital Ptosis (Droopy eyelids in children):

Levator muscle resection

◦This procedure is the shortening of the levator-aponeurosis complex (muscle responsible for raising the eyelid) through a lid-crease incision. The skin incision is hidden either in the existing lid fold or in a new lid fold created to match that of the contralateral eyelid.

Tarso-Frontalis suspension procedure

◦This procedure is designed to augment the patient’s lid elevation through brow elevation. This surgery is performed in those children in which the levator muscle (muscle responsible for raising the eyelid) is very weak. The eyelid is suspended from the frontalis muscle (muscle over the eyebrow), to allow the frontalis muscle to take over the function of the levator muscle and raise the drooping eyelid.

◦Surgical technique: Several materials are available to secure the lids to the frontalis muscles. These materials include:

  • Silicone bands, silicone rods (Preferred Material for ptosis surgery)
  • Autogenous fascia lata: Autogenous fascia lata can be obtained from the leg of patients older than 3 years. This surgery is now almost never performed, because of the morbidity associated with a huge leg incision and surgery to harvest the tissue.
  • Preserved (tissue bank) fascia lata
  • Nonabsorbable suture material (eg, 2-0 Prolene, Nylon (Supramid) or Mersilene)
  • ePTFE (expanded Poly Tetra Fluoro Ethylene), Gore-Tex
  • Autogenous materials used less frequently include palmaris longus tendon and temporalis fascia.

◦Surgical outcome: Patients may not be able to close their eyelids during sleep from a few weeks to several months following surgery. Families must be warned of this outcome before the operation. The problem of open lids during sleep improves with time; however, aggressive lubrication is needed to avoid exposure keratopathy.

Fasanella-Servat procedure

◦The upper lid is elevated by removing a block of tissue from the underside (red, conjunctival eyelid surface) of the lid. This tissue includes the tarsus, conjunctiva, and Müller muscle.
◦This procedure is not commonly performed for cases of congenital ptosis.

Müller muscle–conjunctival resection

◦This surgery is chosen if the eyelid has had a good response to phenylephrine (a medicine which causes papillary dilatation).
◦The conjunctiva and the Müller muscle are marked off, clamped, and sutured. The tissues are resected. Then, the conjunctival layer is closed.
◦This procedure is not commonly performed for cases of congenital ptosis.

Video of Ptosis Surgeries performed by Dr. Debraj Shome, Oculoplastic Surgeon:

 Results & Prognosis post surgery for Congenital Ptosis (Drooping Eyelids):

•The repair of Congenital Ptosis (Droopy eyelids in children) via ptosis surgery (Eye Lift Surgery / Eyelid Lift Surgery) produces excellent functional and cosmetic results. Ptosis surgery can be performed at reasonable cost (price of ptosis surgery). For more information on ptosis & eyelid lift surgery, click here:



Oculoplasty & Oculoplastic Surgery in India

Oculoplasty is a fast growing super-specialty in India, with many institutes now offering fellowship training programs for young oculoplastic surgeons. For eyelid, orbital, brow, lacrimal, socket and mid-face surgery, please seek and look for a good oculoplastic surgeon, Mumbai, Delhi, Chennai, Hyderabad, Kolkata, Pune and most other Indian cities will have a few.

Most of the top oculoplastic surgeons are trained in the Western world and have come back to India post that and costs will be 1/5th the costs you would pay in the US, Europe or Singapore.

Dr. Debraj Shome is one of the best oculoplastic surgeons, top / best orbital surgeons & facial plastic surgeons in the world and is currently based in Mumbai, India. He has received super-specialty training in oculoplastic surgery, facial plastic and cosmetic surgery, eyelid surgery, orbital and lacrimal surgery. For more information on Dr. Shome’s work, please click on:


For appointments with Dr. Debraj Shome:

A lot of our patients visit us from Hyderabad, New Delhi, Chennai, Bangalore, Kolkata, Pune, Ahmedabad, Chandigarh, Jaipur, Nagpur, Kolhapur, Cochin, Trichy, Bhopal, Indore, Assam, Manipur, Mizoram and many other cities in India. Many of our consumers (medical tourism) also come in from the USA, Singapore, Dubai, Qatar, Canada, Nigeria, Kenya, Mauritius, UK, South Africa and many other top countries in the world.

Locally, from Mumbai and the surrounding areas, we cater to consumers from Thakur Village, Thakur Complex, Kandivali, Borivali, Dahisar, Andheri, Dadar, Malad, Powai, South Mumbai, Worli, Thane, Bandra, Santacruz, Chembur, Navi Mumbai, Mira Road, Bhayender, Vashi, Panvel, as we have multiple centers in Mumbai.

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