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Ptosis surgery: treating processes in children’s eye surgery

Children’s eye surgery is done in a paediatric hospital or a hospital that has paediatric services under a general anaesthetic as a day case for the child’s eyes. Clearly, the child cannot be awake for their surgery, and the child would be sedated. An experienced paediatric anaesthetist provides the sedative and Mum, or Dad can come into the anaesthetic room. The anaesthetist uses a little sleeping gas to make the child feel very cosy then gives the anaesthetic, and so they are unaware of needles, and ECGs monitoring equipment and unaware of the theatre surrounds.
Each child’s eyelid takes between 30 and 45 minutes. Very often in adults, the eye will be padded afterwards, but in children usually, no pad is placed. Gone are the days of keeping children in the hospital with their eyelids taped up for two days. All children’s eye surgery is day case, and usually no eye pads because it is much nicer for the child and the parents.
After the children’s eye surgery, there are always lots of drops and ointment to put in to keep the front of the eye moist because the eye will not be entirely close, to begin with, and will look a little bit stiff, and the eye will be open at night. When the child looks downwards, the upper eyelids operated on will “hang up” and look odd at the start. This usually settles.
Mum and Dad have to make sure that everything is alright and that the eye is well protected and they will ask to put some extra ointment. In children, we tend not to use stitches that have to be removed, but instead, we use absorbable ones that can readily dissolve over a few weeks.
If your child has a ptosis, they should be assessed at Clinica London by the orthoptist to measure their visual development and see if they have a squint as well or just the ptosis and then subsequently by the oculoplastic surgeon, Jane Olver. They may require being seen by the paediatric ophthalmologist, Ms Naz Raoof, to have a refraction, meaning individual test for glasses. They may need to be seen more than once so accurate measurements can be obtained. We are all familiar with the terrible twos and a two-year-old child having an eye examination when they can be somewhat uncooperative, so we do not always get all the measurements we want in one sitting. It is useful to see them again when they are about three to repeat measurements and then hopefully get them ready for the ptosis surgery when they are around about four years old.

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