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Procedure to Repair Congenital Eye Ptosis for a Child?

asked 2 years ago by nanihernandez in Santiago, Chile
Latest answer by Jeffrey E. Schreiber, MD
Question viewed 1,887 times
Tags: age 17 or under, eyelids, eyes, female, asymmetry, sagging, cosmetic surgery, vision

My 2 year old daughter has a severe congenital ptosis in her left eye. She was operated when she was two weeks old because the lid was completly closed. They did the resection of the levator muscle and opened the lid a bit. When she was one year old, she had a second resection of the levator muscle because it was very thin and the lid came over her pupil again, so they tightened it a bit more. Now her vision is okay and she is wearing an eye patch for 3 hours daily. Is there any cosmetic surgery that can make her eyes equal? Which procedure would you reccomend? At what age?

4 answers to Procedure to Repair Congenital Eye Ptosis for a Child?

+1

Congenital ptosis

For congenital ptosis, you may want to consider a "frontalis sling." This is great for this type of ptosis, and involved connecting the forehead muscle to the eyelid to keep it opened. I would have to examine you in person to determine the best solution, but this is probably what I would consider just by the picture and history.
Jeffrey E. Schreiber, MD

Baltimore Plastic Surgeon
+1

Symmetry of eyelids

The most important thing to note in your child's journey is the fact that her vision is good. Function always comes before cosmetics. That being said, eyelid symmetry is not perfect in most people if you look for this specifically. Be OK with that fact. The lid position is really a balance between opening and closing, so in photos, we only see a frozen point in time. Do work with a specialist who understands the dynamics in balancing both position and function so that you have no regrets... more
Randy Wong, MD

Honolulu Plastic Surgeon
+1

This requires specialized training and is not considered cosmetic

Dear Nani The first and primary issue with your child is amblyopia. Presumably, she is seeing a pediatric or general ophthalmologist who is managing the eye patching. This forces the left eye to work despite the presence of an eyelid that substantially obstructs the visual axis. As noted in the other responses, what is done for the eyelid position does very much depend on how the eyelid moves. Often in congential ptosis the muscle that raises the eyelid is not properly developed and can't... more
Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon
+1

Congenital ptosis and the frontalis sling procedure

Procedures for congenital ptosis depends on the function of the levator muscle. Most congenital cases have severe muscle weakness(less than 3mm of function tested by moving the upper eye lid upwards). In these cases, levator resection will not work well because the "motor" which is the levator muscle is not working properly. The procedure in this case is a frontalis sling procedure. This procedure relies on the frontalis muscle to act as an upper lid elevator. Hope that helps!... more
Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon

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