What is Congenital Ptosis?
Congenital ptosis: occurs when there is weakness of the levator muscle. It may be unilateral or bilateral. Sometimes, the muscle power is very weak and at other times, there is a moderate weakness in the muscle. It is termed a developmental dystrophy with a decrease in the striated muscle fibers in the muscle, associated with fatty infiltration. The upper eyelid is lower than normal and covers a variable part of the pupil.
Children with congenital ptosis will often raise their eyebrows and the chin, in order to see.
"Well, the last time I had a picture taken I could hardly see my eyes because of the weight of heavy eyelid. Then I paid attention to how I was actually using my eyes and I really noticed when I was looking at anything especially the computer I was straining my forehead to see better. Since I have had it done I no longer have to lift the forehead and tilt my head to see. It is amazing! I love..." D. Rock 63 Yrs Old with Fat Droopy Eyes - Salt Lake City, UT
Will the eye be affected by congenital ptosis?
Congenital ptosis may be associated with anisometropia, strabismus and amblyopia. We will have you assessed carefully by our strabismus experts as strabismus may be present in as many as 30% of children with ptosis and amblyopia may be present if the pupil on one side is covered by the ptotic eyelid. Patching of the eye and/or strabismus evaluation and treatment may be necessary.
What other conditions may be associated with Congenital Ptosis?
Congenital ptosis may be seen in the following congenital conditions:
Marcus Gunn syndrome (1883): this is caused by a congenital mis-connection between the fifth nerve which supplies the pterygoid muscles (move the mouth from side-to-side) and the third nerve (which supplies innervation to lift the eyelid). Therefore, when the child moves the mouth to the side, the eyelid may move up or down. This is also called the jaw-winking syndrome. An accurate assessment allows us to determine the degree of the ptosis and the degree of the wink, allowing us to guide you as to the best course of treatment. 78% of patients with the Marcus Gunn syndrome also have superior rectus weakness.
Blepharophimosis syndrome: this is an autosomal dominant condition consisting of ptosis, blepharophimosis, epicanthic folds, and a few other changes.
Double elevator palsy: there is associated weakness of the levator muscle which raises the eyeball as well as the levator muscle which lifts the eyelid.
Congenital fibrosis syndrome
Moebius syndrome
Anatomy of the eyelids
Is Congenital ptosis hereditary?
Some families have a family history of ptosis and the condition may be seen in several generations in a family. However, most of the time, it is sporadic with no family history.
How is Congenital Ptosis repaired?
When there is a moderate degree of levator function, the muscle is advanced and the eyelid/eyelids elevated. The aim with the levator advancement and the frontalis sling is to give the child or adult a better opening to the eye, allow the vision to develop more normally in the case of a child and to give a nice cosmetic improvement. Most children and adults who have these types of procedures will sleep with their eyelids somewhat open, requiring topical lubricants.
Levator Advancement Procedure for ptosis
with adequate levator function
Before and After
Frontalis Sling
When the weakness is profound, with little or no function, “frontalis slings” are performed. Before a child is 4 or 5 years old, temporary materials are used to elevate the eyelids so that vision may develop more normally.
When the child is older, fascia lata is obtained from the leg to perform slings. The fascia lata slings last much longer as the material is autogenous.
"I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm." D. Gull Highly recommended for eye lift surgery - Salt Lake City, UT
Will the ptosis surgery need to be repeated?
As the child ages, it may be necessary to further advance the levator muscle if there is adequate muscle function. In the case of temporary slings performed early to improve the vision, the more permanent fascia lata slings will need to be performed when the child’s legs are big enough to donate a small strip of fascia lata via a
small incision just above the knee.
What care will I need to give my child after ptosis Surgery
Whether a direct levator advancement procedure is performed or a frontalis sling is performed, it is normal for the child to sleep with the eyelids somewhat open: this may be dramatic in the beginning but the degree of opening reduces over time. However, the lids may stay open to some degree for a long time or forever. This is normal and every child will experience this. After surgery, the following instructions should be followed: Incisions which are hidden in front of and behind the ear. Once healed, they are close to invisible.
The incision sites will need the application of erythromycin eye ointment three times a day for about a week: this will be prescribed.
It will be important to keep the incision sites clean: clean hands!
Any oral antibiotics prescribed (especially important when frontalis slings are performed) must be administered.
For the first few weeks, applying a small amount of eye lubricating ointment (Refresh pm ointment or any other eye lubricating ointment will do) whenever the child sleeps or takes a nap is important. After a few weeks, most children do not need continud application of ointment unless they are unwell or have a cold. We will guide you.
Most children see so much better once the eyelid/eyelids have been lifted that you will notice them being much more physically active! This all to the good!
If patching was prescribed by the paediatric ophthalmology team, please continue with the patching until you see the team again: they will reduce or stop the patching once appropriate.
Most children can return to school within three or four days. There is very little pain after this surgery: children’s Tylenol is usually sufficient.
We will monitor the eyelid height once every six to nine months; the paediatric ophthalmology team will assess visual development and examine you for any strabismus or need for patching as well.
What sort of scars will there be?
When a direct incision is made to lift the eyelid, the incision is hidden in where a natural crease would form. All children heal with a pink scar initialy, but this is almost invisible after a few months. After frontalis slings, the incisions become almost invisible within a few months as we make very small incisions using a technique that we developed at the University of Utah and have taught to surgeons from all over the world. We take pride in our “small-incision” frontalis slings with minimal scars, unlike the way the surgery is performed in many other centers. It is normal to feel small bumps under the skin after frontalis slings as the sling material is attached to the frontalis muscle:
however, these are rarely visible.
"Dr.Patel such a wonderful person...trust worthy, making u feel like family, included his staff members. Made my worries go away with there caring ways. God bless them. He truly make a wonderful job...it seem like a miracle. Dr. Patel makes magic happen." - Vitals.com Visitor Review