Congenital ptosis is most often due to an under-development of the eyelid lifting muscle (the levator). Although usually occurring as an isolated problem, children born with ptosis may also have eye movement abnormalities, muscular diseases, lid tumors or neurological disorders.
Children with ptosis often tilt their heads back into a chin-up posture to see or raise their eyebrows in an effort to raise their lids. If the lid droop affects both eyes, the child’s visual and motor development may be affected. The child may bump into things and may have difficulty walking.
If the lid covers a part of the visual axis, the child's visual development can be affected which could lead to amblyopia (lazy eye). This usually occurs in a child when the lid is drooping severely enough to block vision or cause astigmatism. If not treated early in childhood, the child’s vision will be permanently reduced as a result.
In determining whether surgery is advisable, a detailed assessment is made by an ophthalmologist specialized in treating droopy eyelids. The age of the child, the severity of the ptosis and whether one or both eyelids are involved are factors taken into consideration. Measurement of the lid height, evaluation of the eyelids lifting and closing muscle strength and observation of the eye movements determine which surgical procedure is more appropriate.
The most common procedure involves advancing the under-developed levator muscle or suspending the lids to the brow (brow suspension) while the child is under general anesthesia.