Eyelids are normally equal in height and have a full range of up/down motion, but a small percentage of infants are born with droopy or misshapen eyelids, which can interfere with normal vision development. The most common cause is poor intra-uterine development of the elevator muscle of the eyelid. You may notice your child raising his or her eyebrows and tilting the head backward in order to see.
Ptosis is not just a cosmetic issue; in many cases, it may impede development of sharp vision, and amblyopia (lazy vision) will occur. Misshapen or droopy eyelids are often accompanied by unequal focusing power in the two eyes, which may require eyeglass correction.
Surgical Ptosis Repair
If the amount of lid drooping, abnormal head posture or lazy vision is mild, we may prescribe eye patching and eyeglasses, deferring surgical correction until about kindergarten age. In severe cases, we may need to perform surgical correction in the first year of life. This is to enlarge the field of vision and to ensure sharp visual development; cosmetic concerns are important but secondary to the concern of normal vision.
Surgery performed by an experienced pediatric ophthalmologist has the highest chance of an excellent functional and cosmetic result. Ophthalmologists are highly knowledgeable about eye socket anatomy and the best surgical techniques for the eyelid and surrounding skin.
Pediatric eyelid surgery is performed as an outpatient procedure (hospitalization is usually not required), but sometimes requires multiple operations performed months or years apart.
Serious complications are rare; infection, severely dry eye, or abrasion and ulceration occur in less than 1% of pediatric eyelid procedures, and severe reactions to anesthesia occur in less than 0.5%. There is no known case of transfer of any disease from the use of sterilized and irradiated tendon tissue. Any evidence of abrasion, ulceration or infection may be treated with hospitalization until the pediatric ophthalmologist is confident your child’s eye is lubricating itself properly.
Re-operation is sometimes necessary because of growth of the eyelids and the face, or because of recurrence of drooping. Incomplete eye closure is common in the immediate post-operative period and tends to diminish with time. You can treat your child’s eye with lubricating ointment so it doesn’t become dry. If ointment does not quickly restore normal luster and clearness to the anterior surface of the eye, re-operation may be necessary to adjust the height of the eyelid.
What to Expect
On the night before surgery, don’t give your child food or milk after midnight. Medicines may be taken with sips of water. Only apple juice and water may be taken up to three hours before the admission time. See the Hospital Pre-Op page.
If your child is acutely ill (has a fever, deep cough or vomiting) in the days before surgery, please call us at (817) 529-9949.
The time of day you’ve been given for the operation is tentative and may need to be changed on the day of surgery. In general, patients are taken by age, with the youngest going first.
The anesthesia doctor may order a preoperative oral sedative. A young child will be put to sleep within seconds by breathing gas from a mask held near his or her face. An intravenous (IV) line and a breathing tube (endotracheal tube) are placed only after your child is asleep, and the breathing tube is removed before he or she is fully awake. Children age 13 or older who are not unduly frightened may be given an IV line of sedatives beforehand. Depending on the special needs or medical condition of a patient, the anesthesiologist may slightly alter the routine.
Depending on the amount of drooping and the age of your child, the pediatric surgeon may strengthen the lid muscle by shortening it, using synthetic suture or natural material, or using tendon taken from the child’s outer thigh during surgery. If excess skin is present after elevating the lid, a small strip of eyelid skin may be removed at the same time. The surgery is usually completed within 90 minutes, although this may vary from 45 minutes to two hours depending on the complexity of the case. After the surgery, Dr. Packwood, Norman, or Hunt will find you to discuss the results.
Your child will be taken from the Operating Room to the Post-Anesthesia Recovery Unit, where he or she will awaken more fully while being monitored by the nursing staff. After 15-30 minutes, you’ll be called from the waiting room to join your child. Your child will be encouraged to drink juice or eat a Popsicle while we remove the intravenous line.
Your child’s eyelid might appear puffy and bruised. You may see a few drops of red stained tears draining from the eyes, eyelid incision or brow incision. These can simply be wiped away with a washcloth or tissue. Tiny stitches may be noticeable in the eyelid crease or brow; these absorb over a period of 4-6 weeks and don’t need to be removed.
There may be mild discomfort from the surgery, and mild nausea is common. The nurses will treat any discomfort with appropriate medication and possibly Tylenol. We discharge most patients within two to three hours after surgery.
At the time of discharge, the surgery nurses will provide you with ointment to help healing and prevent infection. Beginning the evening of surgery, squeeze about ¼ inch of the ointment just inside the lower lids and onto the wound 2-3 times a day and at bedtime. After seven days, you can subtitute non-prescription Lacrilube ointment for the antibiotic ointment. If the eye is white and clear and there is no sign of excessive light sensitivity, you can reduce application of lubricating ointment to bedtime only after seven days. If a brow or forehead incision was made, you may feel a bump beneath the skin where the tendon tissue is tied. The bump flattens in the first weeks and months after surgery.
Your child can resume limited activities the day after surgery. Younger children often play within hours after surgery, though some children may be tired, grouchy or nauseated for a day or two. Your child should child avoid submerging his or her eyes in a bath or swimming pool for 7 to 10 days after surgery. Bathing, showering and washing of the hair is permitted, but try to keep the stitches dry. The operated eye may stay open partially when sleeping; it will close better a few weeks after surgery as your child learns to forcefully blink. Redness or puffiness of the eyelids will also disappear in a few weeks. Your child can return to day care or to school within one to two days after surgery.
Our Surgery Scheduler will tell you the day and time to return to our office for a brief post-operative check. If you wish to arrange the appointment yourself, call (817) 529-9949 and tell the receptionist you need to schedule a post-operative check-up. Your child will need to be seen several times in the first few months after the surgery.