Ptosis in children is a condition that occurs when the upper eyelid is positioned lower than its normal anatomical level. Eyelid drooping in children should not be considered solely as an aesthetic issue. As visual development continues, particularly during infancy and childhood, ptosis can potentially lead to outcomes affecting visual function in some cases. If the eyelid partially or completely covers the pupil, clear vision might be hindered, negatively impacting visual development in the long term.
Ptosis in children can arise due to inadequate functioning of the muscle lifting the upper eyelid or disruption of neural transmission. Ptosis in children can be seen in one eye or both eyes. In some children, eyelid drooping is mild, while in others, it can be prominent enough to cover the pupil.
The eyelid being positioned lower than normal can narrow the child's field of vision, lead to changes in head position, and affect visual development over time.
Eyelid drooping (ptosis) in children can result from the upper eyelid lifting muscle or the nerve structures stimulating this muscle being unable to function normally. This condition can be present from birth or develop later in childhood. Accurately determining the cause is essential for planning the follow-up and treatment process.
The main causes of eyelid drooping in children may include:
Congenital causes:
It can develop due to insufficient development of the muscle lifting the upper eyelid (levator muscle) from birth. Congenital ptosis may occur in one or both eyes.
Causes related to muscle and nerve transmission:
Disorders in the nerves stimulating the eyelid muscle can result in insufficient eyelid movement. This can be associated with some neurological conditions.
Trauma-related causes:
The eyelid muscle or nerves may be affected after trauma to the eye area, surgical interventions, or accidents. In this case, acquired ptosis may develop.
Structural issues related to the eyelid:
Masses, edema, or increases in tissue weight developing in the eyelid can cause the lid to sag downwards.
Systemic and muscular diseases:
Rarely, muscle diseases and general health problems can cause eyelid drooping in children.
If ptosis is present from birth, it can become more noticeable in the first months. Detection of ptosis often relies on parental observations, making it important to carefully monitor certain physical and behavioral signs.
Primary signs that may suggest ptosis in infants and children include:
The upper eyelid covering the pupil.
Noticeable asymmetry between the eyes.
Constantly tilting the head backward.
One eye appearing smaller or more closed.
Difficulty looking at light or trying to squint.
Uneven appearance of eyelids in photos.
Ptosis in children can affect vision depending on the degree of the drooping and how much the pupil is covered. Since the visual system is continuing to develop during childhood, ptosis should not be assessed merely as a cosmetic condition.
If the upper eyelid covers the pupil, the amount of light entering the eye may decrease, and a clear image cannot be transmitted to the brain. Over time, if this persists, visual development might be adversely affected.
Possible effects of ptosis on vision in children include:
Closure of the visual axis
Risk of lazy eye (amblyopia)
Change in head and posture position
Disruption in depth perception
When planning the treatment for ptosis in infants and children, the degree of ptosis, to what extent it obstructs the pupil, its impact on visual development, and the child's age are considered together. The aim is not only to correct the appearance of the eyelid but also to preserve visual development and prevent possible permanent issues.
If eyelid drooping is mild and does not cover the pupil, vision is generally unaffected. In such cases, regular monitoring may suffice. However, if the eyelid partially or completely blocks the visual axis, early intervention may be necessary.
During infancy and early childhood, the visual system develops rapidly. Reduced visual stimuli entering the eye due to ptosis can increase the risk of developing lazy eye (amblyopia). In cases where this risk is present, the treatment plan is closely monitored, and surgical options are considered if necessary.
The timing of treatment is determined by considering the child's age and health condition. Immediate surgery is not required for every case of ptosis. In some infants, visual development can be observed for a period before deciding on surgery.
Ptosis treatment in infants and ptosis surgery in children are generally planned in conditions threatening vision. The decision for surgery considers the function of the eyelid muscle, the severity of ptosis, and its effects on vision. The goal of surgical intervention is to reposition the eyelid to a more functional location, opening the visual axis.
Yes, if the upper eyelid covers the pupil and this condition persists for a long time, the risk of developing lazy eye increases. Therefore, early diagnosis and follow-up are crucial.
Symptoms of ptosis in children may include trying to look by tilting the head backward or noticeable asymmetry between the eyes. In some cases, this can affect visual development, making early evaluation important.
Ptosis surgery in children is planned based on the function of the muscle lifting the upper eyelid and the degree of drooping. The surgery is generally performed under general anesthesia in children, with the goal of positioning the eyelid so it does not obstruct the visual axis and is in a functional position. Post-surgery, the recovery and visual development are monitored with regular check-ups.
The age for surgery is not fixed. In cases where the visual axis is obstructed and there is a risk of lazy eye, surgery may be considered at an earlier age. Each child is evaluated individually.
