Definition   
– Drooping of the upper eyelid

Aetiology    
– Congenital
- Idiopathic, Hereditary
- Acquired
- Traumatic
- Mechanical
- Neurogenic
– 3rd nerve palsy
- Sympathetic palsy – Horner’s Syndrome
- Myasthenia gravis

If total ptosis exists deprivational amblyopia could occur.  This is rare.  But anisometropic amblyopia is common, because of associated astigmatism.

For Further discussion of amblyopia

Management
– Test vision and perform a refraction to exclude amblyopia

Monitor vision and refraction
Many children with congenital ptosis do not close their eyelid fully while sleeping.

Surgery at 3 – 4 year- earlier if ptosis is obstructing vision.

Surgery


- Partial Ptosis
- the muscle of elevation
–Levator Palpebrae Superioris can be effectively adjusted to correct the eyelid height. This operation is performed through an incision which is placed in the eyelid skin crease. It is effectively hidden when the eye opens.

This surgery is very effective. In 95% of cases the eyelid elevates to the desired height postoperatively. Rarely it may be necessary to adjust the eyelid position to attain maximal correction postoperatively

Commonly the tendency to sleep with the eyelid open may be exaggerated in the early postoperative period.

Possible Complication of Surgery
– corneal exposure may occur- an extremely rare complication in children.

Total Ptosis:
Surgery to correct this involves attaching the eyelid muscles to the muscles of the forehead- Frontalis Sling Procedure. The ideal material

For this is fascia from the patient’s own thigh. This Fascia is a living graft and grows with the patient becoming incorporated in the eyelid tissues and results in a permanent cure. Various artificial materials are available for use but they all have limited effectiveness. Their use should be limited to correction of total ptosis in infants when fascia cannot be used. In these cases revision of the surgery using living fascia is usually necessary at a later age.