Congenital ptosis (drooping eyelid)

In principle, there are 2 different surgical techniques. Which one is chosen depends on the condition of the levator muscle and the extent of the ptosis. After the examination, we will discuss the findings with you in detail and plan the further procedure for your child with you.

If the function of the levator muscle is still relatively good, we will suggest the so-called levator resection. Here, the levator muscle is shortened and thus strengthened. Through an incision in the eyelid crease, the levator muscle is shortened by a precisely defined length. The incision is then closed with self-dissolving sutures. The operation is performed under general anesthesia.

If the function of the levator muscle is weak, the so-called frontalis suspension is recommended. Here, a sling is placed under the muscle and connected to the eyebrow. This sling is inserted through small, approximately 5mm long punctures above the eyebrows and in the upper eyelid area. This sling is now tightened until the position of the upper eyelid reaches the desired height. The punctures on the eyebrows are closed with self-absorbing sutures, those in the eyelid area heal without sutures. The operation is performed under general anesthesia in children. In cooperative adults, only local anesthesia is also possible.

If the ptosis is mild and the eye is not in danger of becoming weak-sighted, the operation can be postponed for the time being and regular check-ups are arranged. At the latest at the beginning of puberty, the operation should be considered in order to take the psychological pressure off your child.

If your child's vision is in danger, early surgery is necessary to support normal vision development and prevent amblyopia.

In 15% of cases it can happen that after the surgery of one or both upper eyelids a good result is achieved for the single eye, but there is a certain asymmetry between the eyelid opening of both eyes. Avoiding this is not always successful, as the healing process can significantly change the eyelid height.

In addition, it should be noted that perfect symmetry of both upper eyelids is rare even in the healthy eye. A certain lateral difference after surgery is natural and should be tolerated.

The final eyelid height is not stable until about 6 months after surgery. Until then, there may be under- or over-correction. If after 6 months there is still a significant difference (> 2mm), then we will suggest a re-operation if necessary.

In acquired ptosis in adults, the eyelid elevator muscle functions normally and "only" needs to be raised to the correct height. In congenital ptosis in children, the eyelid elevator muscle functions insufficiently. Simply raising the muscle is not enough: the muscle must be shortened. As a result, the eyelid height is then better when looking straight ahead, but the upper eyelid remains "stationary" when looking down. This is the so-called eyelid lag and it is unavoidable. Your child will learn compensation mechanisms after the operation so that the eyelid lag is not too noticeable.