A drooping eyelid is called a ptosis, and many children are born with one eyelid appearing to droop more than the other, which is called a congenital ptosis. If the eyelid is not opening properly, it is highly important that your child is assessed to make sure that the eye underneath the eyelid is normal and has a chance of developing its vision well. I have sometimes been called to the hospital to see a child with a droopy eyelid aged only three weeks old, one child’s eyelid just did not open. The important thing is to make sure that the child can see out. They had a paediatric ophthalmology assessment to check the retina after putting in some eye drops and to check that they did not have any abnormality such as cataract or problem at the back of the eye such as retinoblastoma, then correct the ptosis.
Usually, however, the droopy eyelid is only partial and does not cover all of the pupil, and we can wait until they are around the age of four years old before correcting the ptosis surgically. Sometimes a drooping eyelid can cause astigmatism and a subsequent lazy eye, as well as being cosmetically unattractive, and glasses and patching are required.
At Clinica London, Ms Naz Raoof looks after visual development in children with drooping eyelids. Ms Naz Raoof is the paediatric ophthalmologist, neuro-ophthalmologist and adult strabismologist, who together with her orthoptists Gina Harris and Joe McQuillan, assesses the development of your child’s vision, ensure that they do not require glasses or patching and make sure that the two eyes are working well together, as well as exclude squint, cataract, retinoblastoma or developmental anomaly. Ms Naz Raoof operates on children with a squint. Ms Jane Olver, the oculoplastic surgeon, does ptosis surgery, relying on Ms Naz Raoof to firstly assess and advise on the visual development and whether glasses or patching are required.
It is best to correct ptosis by the latest age of four to five years before they go to school and get possibly teased and at an age where they probably do not remember an awful lot about having the surgery done.
Drooping eye surgery is called ptosis surgery and is done by Jane Olver the Oculoplastic Surgeon at Clinica London. The actual surgery takes place at the Harley Street Clinic after initial assessment and measurements at Clinica London. The reason the ptosis surgery or eyelid lifting is done at the Harley Street Clinic is that your child has to have a short anaesthetic for about half an hour for the eyelid to be operated on. After the surgery, they can sometimes have an eye patch, but usually, we find children do not like eye patches, so we just put some ointment on the front of the eye. The stitches used on the eyelid skin in the skin crease are barely visible and are dissolvable. Follow up is back at Clinica London.
After surgery, some eyedrops have to be put in the eye for between one to three weeks to keep it lubricated immediately after the eyelid surgery, because otherwise, the eye may feel a little bit dry while the eyelid is getting its full function back. Having eyelid surgery gives the eyelid a little bit of bruise, and so it does not work or move quite so efficiently and is rather a stiff eyelid for two to three weeks.
There has been a lot of work done with the quality of life studies on children with ptosis and with children with a squint, which show that there is a big benefit in their psychosocial function and education if their squint or drooping eyelid is corrected surgically. In the next blog, I will talk a little bit about squint surgery.