What is Congenital Ptosis (Eyelid Droop)?
Congenital eyelid ptosis is a condition characterized by an abnormal drooping of one or both upper eyelids that is present at birth or shortly thereafter.
Congenital ptosis is most commonly due to maldevelopment (or even absence) of the levator palpebrae superioris muscle, the muscle that lifts the eyelid. In these cases, instead of a healthy functioning muscle to lift it, the eyelid has fibrotic (scar-like) tissue that allows very minimal movement of the eyelid, if any at all.
FINDINGS Patients with congenital ptosis often have a droopy eyelid that fails to lift with attempts to open their eyes. The eyelid commonly has no - or minimally - visible eyelid crease. This is due to the fact that an eyelid crease is formed by attachments of the eyelid levator muscle to the undersurface of the eyelid skin. In the absence of a normal muscle, the eyelid crease fails to form.
Patients with congenital ptosis tend to adopt a "chin-up" head position (particularly in cases when both upper eyelids are affected) and arch their brows to force eye opening. [The muscle that lifts the brows can also lift the eyelids, albeit less effectively than the eyelid levator muscle and to a much lesser degree. That is why when you try to open your eyes wide, your brows lift as well.]
A severe eyelid droopy can potentially interfere with a child's visual development and cause irreversible vision loss, a condition called amblyopia. For this reason, early recognition and surgical repair is extremely important.
In my practice, I repair eyelid ptosis quite frequently, particularly in children. There are several techniques to repairing eyelid ptosis in children. The technique most suitable for each pediatric patient depends on the degree of eyelid ptosis and the strength of the muscle that lifts the eyelid (the levator palpebrae superioris). In general (although exceptions do exist), mild eyelid ptosis with a strong levator muscle may be repaired with an internal approach through the inside of the eyelid, a procedure called conjunctivo-Mullerectomy. Moderate eyelid ptosis with a functioning levator muscle may be repaired with an external approach through the eyelid skin, a procedure called levator advancement. Severe eyelid ptosis with a weak or non-functioning levator muscle may be repaired with a procedure that involves taking advantage of the forehead muscles to lift the eyelids and open the eyes, a procedure called a frontalis sling.
On my most recent medical mission trip to San Cristóbal de Las Casas in Chiapas, Mexico, Dr. Abboud operated on an infant girl with congenital right upper eyelid ptosis using a scarless internal approach (the incision is on the inside of the eyelid). Even at two weeks after surgery, the little girl’s eyelid had lifted and her eyes appeared more symmetric.
During the same mission trip, I met a 43-year-old lady who had bilateral congenital eyelid ptosis. Neither she nor her parents had been able to afford surgery to correct her ptosis. As a result, she never had eyelid ptosis repair as a child. Luckily, she had good vision in both eyes. Up until I met her, she had been compensating for her droopy eyelids by constantly lifting her brows and adopting a "chin-up" head position. That allowed her to see only from the bottom of her eyes. Her eyelid levator muscles were too weak to be corrected with levator muscle tightening techniques. Instead, I performed a frontalis sling procedure and re-created an eyelid crease on both sides. Immediately after surgery, her eyes appeared more open and she quickly normalized her head position.
Recently, one of my patients in San Diego came to me with a droopy left upper eyelid that had been present since birth. He had initially undergone corrective surgery when he was a child. When he was 13 years old, he underwent another revisional surgery with placement of a frontalis sling. Due to complications and eyelid scarring, the sling was removed soon after and the eyelid remained droopy for 40 years until he saw me! I performed repair of his congenital ptosis with placement of a silicone frontalis sling and I re-created an eyelid crease. He could not have been happier with the results!
Of note, patients with congenital ptosis may require several corrective eyelid procedures, particularly as they grow.
For more information about congenital ptosis or to schedule a consultation, call us at 858.356.2647
— These are images of actual patients of Dr. Jean-Paul Abboud. They are shown for informational purposes only and are provided with patient consent for use on this website. Please do not copy or distribute images/videos. Each individual’s treatment and/or results will vary, and no guarantee is stated or implied by any photo or statement used on this website.