Congenital Ptosis (Drooping Eyelids)

Definition and causes

“Ptosis” is the medical term for a drooping upper eyelid. There are two reasons why an eyelid droops: there’s a either a problem with the “levator” muscles that lift the eyelids, or a problem with the nerve that controls them. There are a number of causes – trauma, infection, cancer, autoimmune or inflammatory disease, and sometimes ptosis can be hereditary.

It’s caused by a dysfunction in either the muscles that raise the eyelid, or the nerves that control those muscles. Ptosis can occur on its own, but it can also be associated with trauma, autoimmune or inflammatory disease, infection, cancer, and in some cases, hereditary disease.

Sometimes, the ptosis is mild, and the upper eyelid droops only slightly. But in moderate-to-severe cases, the upper lid may partially or completely cover the pupil. This is of particular concern in children, ptosis that covers the pupil can cause amblyopia: the part of the brain that deals with vision from that eye just doesn’t develop properly as it isn’t receiving as much information from this partially closed eye.

Instinctively, children try to compensate for this by the following behaviours:

  • Putting their head back and lifting their chin
  • Lifting the drooping eyelid with their fingers
  • Raising the eyebrow to help lift the upper eyelid more.

But if you have a child with an eyelid that covers the pupil and they don’t use these compensating mechanisms, then it’s important that they get seen by a professional quickly: the ptosis can cause visual suppression, and can leave your child with permanent, lifelong amblyopia.

Congenital ptosis is usually based on a malformation of the muscle (levator muscle), which should raise the upper eyelid. This change can affect either one or both upper eyelids. Other, rarer causes of congenital ptosis may include: certain muscle diseases, tumors of the eyelids or neurological disorders.
 

The operation

There are two surgical techniques that can be used to correct ptosis – levator resection and frontal suspension. Which one is chosen depends on the condition of the levator muscle and the extent of ptosis. After we examine you, we will discuss the findings together with you and plan the further procedure for you (or your child).

Levator resection

If the function of the levator muscle is still relatively intact, we will suggest what’s called levator resection: the levator muscle is shortened and strengthened. We do this by making a cut in the eyelid crease, then shortening the levator muscle by a predetermined and precisely defined length. The incision is later closed with self-dissolving stitches, and the entire operation is performed under general anaesthesia

Frontalis suspension

If the function of the levator muscle is weak, we typically perform what’s called frontalis suspension surgery. The surgeon places a sling under the muscle and connects it with the eyebrow. This loop is inserted through small, approximately 5 mm-long punctures over the eyebrows and in the upper lid area. This sling is then tightened until the position of the upper lid reaches the desired height. The punctures on the eyebrows are closed with self-resecting sutures – those in the eyelid heal without suture. The operation is performed under general anaesthesia.

When to operate?

If the ptosis is mild and the eye is not in danger of developing amblyopia, the operation can be postponed, and we will monitor the situation before intervening. However, we would suggest that the operation be considered at the onset of puberty, in order to relieve the psychological pressure on your child that other children might place on your child.
However, if your child’s vision is at risk, early surgery is needed to support normal vision and prevent amblyopia.

The “perfect” symmetry

We aim for perfection, but it’s important to realize that in about 15% of cases where we’ve operated on one or two eyelids, we might have a good result, but thanks to the healing processes potentially changing lid height, the patient might still end up with a small asymmetry between the eyelid opening height of both eyes. Having said that, these small differences are natural – many people have this, and this should be tolerated, especially because the final lid height is only stable after about 6 months after surgery – until then, it might appear that there is under- or over-correction. If there is still a clear difference after 6 months (> 2mm), then, if appropriate, we will suggest a re-operation.

Lid Lag

In acquired ptosis in adulthood, the levator muscle functions normally and “only” needs to be raised to the correct height. In children with congenital ptosis, the eyelid muscle doesn’t work sufficiently well enough to lift the eyelid completely. Raising the muscle alone is not enough: the muscle must be shortened. This results in a normal-looking eyelid height when looking straight ahead, but the upper eyelid “stops” moving below that level when looking down. This is called “lid lag” and unavoidable – but your child will learn to compensate for this after surgery so that the lid lag is not too noticeable.

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Augeninstitut ELZA
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Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
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