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In this video, I want to talk about droopy eyelids in children and what we do to fix them. We have a saying in medicine that children are not just little adults, meaning we can't approach pediatric problems in the same way we approach adult problems. They have to be looked at in a unique way.

A very common problem I see in children is droopy eyelids, often from birth, which is called a Congenital Ptosis. This is most commonly due to a malformation of the muscle which raises the eyelid. The muscle is scarred and may never properly raise the eyelid or relax, allowing the eyelid to fully close. This can be a difficult problem to fix and the different types of surgery, and when we perform them, depend on how much the eyelid moves when the child looks up and down and to what degree the eyelid is blocking vision. In mild cases where the eyelid is only slightly droopy and does not block that child's vision, it's often adequate to wait until they are much older to fix the eyelid. The most important thing is to have them followed by a pediatric ophthalmologist and make sure they don't need glasses to correct any refractive error.

There are three main types of surgery we use to fix a droopy eyelid. The first, used for mild cases, involves an incision through the eyelid skin in the normal eyelid fold. The muscle that raises the eyelid is shortened slightly to allow it to open the eyelid fully. In mild to moderate cases, the surgery performed on the underside of the eyelid can also be used to shorten the muscles that raise the eyelid. This procedure works well when there is about one to two millimeters of droopiness compared to the opposite side. In the most severe cases, where the eyelid does not move, more than a millimeter or two when the patient looks up and down, or the eyelid is completely closed, a sling is used to hold up the eyelid. This involves implanting material which attaches the end of the eyelid to the brow muscles. This is run under the skin, it can not be seen. When the child raises the eyebrow, the eyelid comes up. Although not cosmetically perfect, the surgery is effective in bringing up the eyelid and allowing the child to see with both eyes.

In children, the most common complications are that the eyelid is not completely corrected after surgery. Unfortunately, children can not be awake during the procedure and it's tough to judge the exact position in which to put the eyelids. After surgery, sometimes it's necessary to repeat the procedure to get the optimal effect. Also, it's common that as children grow up, they may need repeated surgery throughout their lives. Other problems such as pain, bleeding, or infection are very rare in children with the surgery.

Droopy Eyelids in Children

Dr. Matheson Harris discusses droopy eyelids in children, also known as congenital ptosis. There are 3 main treatment options to raise the eyelid.