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Ptosis - infants and children

Blepharoptosis - children; Congenital ptosis; Eyelid drooping - children; Eyelid drooping - amblyopia; Eyelid drooping - astigmatism

Ptosis (eyelid drooping) in infants and children is when the upper eyelid is lower than it should be. This may occur in one or both eyes. Eyelid drooping that occurs at birth or within the first year is called congenital ptosis.

Considerations

Ptosis in infants and children is often due to a problem with the muscle that raises the eyelid. A nerve problem in the eyelid can also cause it to droop.

Ptosis may also occur due to other conditions. Some of these include:

  • Trauma at birth (such as from the use of forceps)
  • Eye movement disorders
  • Brain and nervous system problems
  • Eyelid tumors or growths

Eyelid drooping that occurs later in childhood or adulthood may have other causes.

SYMPTOMS

Children with ptosis may tip their head back to see. They may raise their eyebrows to try to move the eyelid up. You may notice:

  • Drooping of one or both eyelids
  • Increased tearing
  • Blocked vision (from severe eyelid drooping)

EXAMS AND TESTS

The health care provider will do a physical exam to determine the cause.

The provider also may do certain tests:

Other tests may be done to check for diseases or illnesses that may be causing ptosis.

TREATMENT

Eyelid lift surgery can repair drooping upper eyelids.

  • If vision is not affected, surgery can wait until age 3 to 4 when the child has grown a little bigger.
  • In severe cases, surgery is needed right away to prevent "lazy eye" (amblyopia).

The provider will also treat any eye problems from ptosis. Your child may need to:

  • Wear an eye patch to strengthen vision in the weaker eye.
  • Wear special glasses to correct an uneven curve of the cornea that causes blurred vision (astigmatism).

Children with mild ptosis should have regular eye exams to make sure amblyopia does not develop.

Surgery works well to improve the look and function of the eye. Some children need more than one surgery.

When to Contact a Medical Professional

Contact your provider if:

  • You notice your child has a drooping eyelid
  • One eyelid suddenly droops or closes

References

Dowling JJ, North KN, Goebel HH, Beggs AH. Congenital and other structural myopathies. In: Darras BT, Jones HR, Ryan MM, DeVivo DC, eds. Neuromuscular Disorders of Infancy, Childhood, and Adolescence. 2nd ed. Waltham, MA: Elsevier Academic Press; 2015:chap 28.

Olitsky SE, Marsh JD. Abnormalities of the lids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 642.

  • Ptosis - drooping of the eyelid

    Ptosis - drooping of the eyelid - illustration

    Drooping of the eyelid is called ptosis. Ptosis may result from damage to the nerve that controls the muscles of the eyelid, problems with the muscle strength (as in myasthenia gravis), or from swelling of the lid.

    Ptosis - drooping of the eyelid

    illustration

    • Ptosis - drooping of the eyelid

      Ptosis - drooping of the eyelid - illustration

      Drooping of the eyelid is called ptosis. Ptosis may result from damage to the nerve that controls the muscles of the eyelid, problems with the muscle strength (as in myasthenia gravis), or from swelling of the lid.

      Ptosis - drooping of the eyelid

      illustration

     

    Review Date: 2/28/2019

    Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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