Drooping of one or both eyelids in infants can be a serious health issue. During this stage of incomplete visual development, if more than half of the pupil is covered due to droopy eyelid, untreated it can lead to gradual vision loss and the development of lazy eye. If not detected early, lazy eye can worsen, and its treatment can be lengthy and challenging.
In a child with congenital eyelid drooping, without any other underlying conditions, the muscle responsible for lifting the eyelid (levator palpebrae muscle) has not developed properly since birth. When this muscle doesn’t function, the affected individual compensates by lifting the same-side eyebrow or, in cases of bilateral drooping, by lifting the chin to see.
Frontalis Suspension Surgery for Ptosis in Infants
In the presence of congenital ptosis where the visual axis is more than half covered, surgery can be performed in infants starting from 3-4 months of age. Frontalis suspension surgery is performed to lift and open the eyelid using the frontal muscle located in the forehead since the levator muscle, responsible for lifting the eyelid, has not developed. A flexible material called silicone sling is used for this suspension in infants and children under 3 years old.
Frontalis suspension surgery can be performed on one or both eyes in the same procedure by an oculoplastic specialist. The surgery is performed under general anesthesia and typically takes around 20-30 minutes. Skin incisions are made in the marked areas on the eyelid and eyebrow, which heal without leaving visible scars. After the suspension surgery, the eyelid may remain partially open during sleep. To prevent any damage to the exposed eye while sleeping, lubricating eye gel can be applied, which usually avoids corneal complications in children. However, if the eyelid is inadequately or excessively lifted in some cases or if there is trauma to the forehead area, it may be necessary to adjust or correct the suspension at a later date.
Frontalis suspension surgery helps to open the visual axis and reduces the risk of lazy eye. However, there may be some degree of asymmetry. This surgery is performed for functional purposes rather than cosmetic reasons in children, but corrective procedures can be performed in later years if eyelid asymmetry persists. It is a reversible and modifiable surgery.
Especially in infants and children with these symptoms, even if there is not severe eyelid drooping, the eyelid’s pressure on the eyeball can cause astigmatism, leading to lazy eye. A comprehensive eye examination should also assess the need for glasses, and if necessary, glasses should be prescribed.