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. Vision development can be affected by the degree of ptosis.
“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
- Contact lenses: we were never really meant to put a piece of glass (albeit a rather clever and useful one!) for up to 18 hours a day onto our conreas. Little surprise, then, that the wearing of contact lenses does stretch the levator aponeurosis a little faster and ptosis is not uncommon in patients who wear contact lenses.
- Trauma: injury may cause the levator aponeurosis to disinsert.
- Rarer conditions such as Horner’s syndrome, myasthenia gravis, chronic progressive external ophthalmoplegia, IIIrd nerve palsy, etc may also cause ptosis which may require a different approach from a direct surgical tightening of the levator aponeurosis which is what is being discussed here.
IS CONGENITAL PTOSIS HEREDITARY?
HOW IS CONGENITAL PTOSIS REPAIRED?
LEVATOR ADVANCEMENT PROCEDURE FOR PTOSIS WITH ADEQUATE LEVATOR FUNCTION
BEFORE AND AFTER
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.
BEFORE AND AFTER PHOTOS OF CONGENITAL PTOSIS
“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?
small incision just above the knee.
WHAT CARE WILL I NEED TO GIVE MY CHILD AFTER PTOSIS SURGERY
- 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.
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