Congenital ptosis (Droopy eyelid in babies and children)

Congenital Ptosis (Drooping Eyelid Present from Birth)

Congenital ptosis refers to a drooping of the upper eyelid that is present at birth or develops very early in infancy. It can affect one or both eyelids and varies in severity — from a mild cosmetic difference to a significant obstruction of vision. Because vision develops rapidly in early childhood, timely recognition and treatment of congenital ptosis is important to support healthy visual development.

​

What Causes Congenital Ptosis?

In most cases, congenital ptosis is caused by underdevelopment of the levator muscle, the main muscle responsible for lifting the upper eyelid. This condition is not usually associated with any underlying illness or syndrome, although in some cases, ptosis can be part of a more complex neurological or muscular condition.

​

Why Is Early Diagnosis Important?

A drooping eyelid in a child can block part of their visual field. If this obstruction is significant, the brain may not receive the visual signals it needs to develop normal sight in that eye. This can lead to:

• Amblyopia (lazy eye)

• Astigmatism (caused by pressure on the cornea)

• Poor binocular vision or eye misalignment (strabismus)

Early diagnosis and appropriate monitoring are essential to prevent permanent visual impairment. Even in milder cases, children may compensate by tilting their head backward or raising their eyebrows constantly, which can lead to posture issues or fatigue.

​

When Is Surgery Recommended?

Surgical treatment is considered when:

• The eyelid is obstructing the visual axis

• Amblyopia (lazy eye) is developing or at risk

• The child is adopting an abnormal head posture to see

• There are cosmetic or psychological concerns (especially as the child grows older)

In more severe cases, surgery may be recommended within the first year of life. In less urgent cases, it may be delayed until the child is older and more cooperative for examination and surgery.

 

Modern Surgical Treatment: Autologous Frontalis Advancement Flap

There are several surgical techniques for correcting congenital ptosis, depending on the severity and the function of the levator muscle. When the levator muscle is very weak or absent, traditional approaches often involve suspending the eyelid using a sling made of either synthetic material or fascia taken from the thigh (autologous fascia lata). However, both techniques have potential downsides, including visible leg scars or long-term complications with artificial materials.

Miss Ting specialises in the autologous frontalis advancement flap — a modern surgical technique that:

• Uses the child’s own forehead (frontalis) muscle to lift the eyelid

• Avoids the use of synthetic sling material

• Eliminates the need for harvesting fascia from the leg, meaning no second surgical site or leg scar

• Achieves natural movement of the eyelid linked to eyebrow elevation

• Offers excellent long-term outcomes with lower risk of complications

This technique is safe, effective, and well-suited to children with poor levator function who require durable correction.

 

What to Expect After Surgery

• Surgery is typically performed under general anaesthetic and patients can go home on the same day

• Children may experience swelling and bruising for the first 2 weeks

• A protective ointment and possibly an eye shield will be used during healing

• Follow-up is essential to monitor eyelid position, visual development, and eye health

• In some cases, minor adjustments may be needed later as the child grows

 

A Personalised and Specialist Approach

Miss Ting has experience treating congenital ptosis in children of all ages. She works closely with paediatric ophthalmologists and orthoptists to ensure a multidisciplinary approach that prioritises your child’s vision, comfort, and confidence. She will take the time to assess your child carefully and guide you through the best treatment options available. Miss Ting understands that the thought of your child undergoing surgery can be stressful and emotional, and she is committed to supporting both patients and their parents with clear guidance, reassurance, and compassionate care throughout the entire process.

​