Procedure to Repair Congenital Eye Ptosis for a Child?

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?

Doctor Answers 4

Congenital ptosis

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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.

Symmetry of eyelids

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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 after the next procedure.

This requires specialized training and is not considered cosmetic

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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 generate sufficient force. This upper ward movement of the eyelid is called levator function. Not having examined her, it is difficult to say what surgery she now needs. She does elevate the left eyebrow in an effort to use the left eye which is good. She also has a formed and distinct eyelid fold suggesting that she has some degree of levator function.

What you need is a oculoplastic surgeon. This is a surgeon who it trained in ophthalmology and also fellowship trained in oculoplastic surgery. In Santiago, there are two very well United States trained oculoplastic surgeons: Rodrigo Poblete and Rosa Balcells are both in Santiago de Chile. Either should be excellent. If for some reason who wanted an additional opinion, Bascom Palmer Eye Institute in Miami very much caters to South American patients and would be a logical choice but I think you will be in very good hands with the individuals noted above.

Due to the interference of the eyelid position with vision, most would advocate doing more surgery now to improve the eyelid function as well as the appearance.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Congenital ptosis and the frontalis sling procedure

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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!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

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