It is a congenital droopy eyelid that occurs due to different reasons. It can be seen in both eyes or unilaterally. Although different studies have different results, approximately 18 droopy eyelids occur in every 1,000 births.
What should the normal eyelid shape, opening, and height be like?
Normally, the distance between the lower and upper eyelids is approximately 8-10 mm, although it varies slightly depending on age, gender, and race. Our upper eyelid extends from the inside to the outside in a concave shape. Our upper eyelid covers the transparent part of the eye, which we call the cornea, approximately 1 mm from the top. Our upper eyelid should not cover the main line that we call the visual axis and that allows us to see. If it closes, it causes progressive and serious vision loss, especially in children.
What are the causes of Congenital Ptosis?
There are two important structures that lift our eyelids.
Levator palpebra muscle; This muscle is a muscle that opens our eyelid and keeps it at a certain level. The other is; 3. Upper branch of the cranial nerve; This nerve is the nerve that innervates the levator muscle, enabling the muscle to function.
Some congenital damage to both the muscles and nerves can cause droopy eyelids. Among these;
- Lack of development of the levator muscle
- Congenital blepharophimosis syndrome
- Horner syndrome
- Some genetic diseases
- Duane retraction syndrome
- It can be seen in many diseases such as Marcus Gann syndrome.
Is drooping eyelid dangerous?
If eyelid ptosis is at a level that prevents vision during childhood, it is dangerous. It causes serious amblyopia, which we call deprivation amblyopia, which if left untreated will cause permanent vision loss after a certain age. Again, droopy eyelids can cause astigmatism because they put pressure on the pupil for a long time.
What is the treatment of Congenital Ptosis?
The definitive and only treatment for this disease is surgery. With surgery, the eyelid is adjusted according to the shape and level of the other eye. But of course;
- Severity of ptosis
- Level of the eyelid
- Unilateral or bilateral?
- Does it block the visual axis?
The decision for surgery should be made considering all these situations.
When should surgery be performed?
If the eyelid has drooped in a way that blocks the visual axis, that is, vision, surgery should be performed as soon as possible to prevent amblyopia from developing. If it does not cover the visual axis, these children should be closely monitored for amblyopia and astigmatism. It would be appropriate for these children to undergo surgery before school to prevent them from experiencing both social and psychological problems.