Eyelid slit in children and infants causes symptoms and effective treatment

Eyelid crease (ptosis) in children and infants is a condition that worries many parents because it appears as an unusual fold or indentation in the upper eyelid. This condition can sometimes be mild and temporary, but in other cases, it may indicate an underlying health issue that requires careful monitoring by a pediatric ophthalmologist. In this article from Dalili Medical, we will discuss in detail the causes of eyelid crease, its types, symptoms, stages, diagnostic methods, treatments with medications, surgery, and laser, as well as important tips for parents. If you notice any changes in your child’s eyelid, this article will help you understand the difference between mild and serious cases and act quickly to protect your child’s eye health.

1️⃣ What is Eyelid Crease (Ptosis) in Children?

Eyelid crease, or ptosis, is an abnormal drooping of the upper eyelid. It can be mild or cover part of the eye, potentially affecting vision.

2️⃣ Is Eyelid Crease Normal in Infants?

No, it’s not considered normal. Some mild cases may be temporary, but most eyelid creases require evaluation by a pediatric ophthalmologist.

3️⃣ Causes of Eyelid Crease in Children

Congenital causes: defects in the eyelid lifting muscle.
Muscular or neurological causes.
Injuries or rare diseases.

4️⃣ Can Eyelid Crease Affect Vision?

Yes, especially if the eyelid covers part of the cornea for a long period, which can lead to lazy eye (Amblyopia).

5️⃣ Can Eyelid Crease Improve on Its Own?

Mild or temporary cases may improve, but most require medical monitoring and treatment.

6️⃣ How to Differentiate Eyelid Crease from Strabismus?

Strabismus causes the eye to move in a different direction, whereas eyelid crease is a drooping of the eyelid itself.

7️⃣ Is Non-Surgical Treatment Possible?

In mild cases, medications or exercises may help, but severe cases usually require surgery.

8️⃣ When Should You See a Doctor Immediately?

If the eyelid covers most of the eye.
If the child has vision weakness or lazy eye.
If the crease appears suddenly after an injury or illness.

9️⃣ Can Eyelid Crease Be Hereditary?

Yes, some congenital cases may have a genetic factor.

10️⃣ Are Exercises Useful?

Exercises can help in mild cases or after surgery to improve eyelid movement, but they cannot replace surgery in severe cases.

11️⃣ Does Eyelid Crease Appear in One or Both Eyes?

It can appear in one eye (unilateral) or both eyes (bilateral), which helps doctors identify the cause.

12️⃣ Does Eyelid Crease Change With Sleep or Fatigue?

Sometimes the eyelid may look thinner or more relaxed during sleep, but persistent drooping requires medical evaluation.

13️⃣ Is Surgery Always Successful?

Most surgeries greatly improve the eyelid, but occasionally, a child may need additional correction.

14️⃣ Is Eyelid Crease More Dangerous in Infants?

Yes, infants’ eyes are very sensitive, and any impact on vision may cause lazy eye or learning difficulties.

15️⃣ Can Nutrition or Vitamins Help?

Not directly, but healthy nutrition and supporting eye health can aid recovery after treatment.

16️⃣ Can Eyelid Crease Affect Learning?

If the eyelid covers the eye for a long time, it may lead to lazy eye, affecting focus and learning.

17️⃣ Is Eyelid Crease Painful?

Usually not, but it may cause eye fatigue or headaches from the child trying to lift the eyelid.

18️⃣ Can Eyelid Crease Appear Suddenly?

Rarely. Most creases are present at birth or develop gradually, but sudden appearance after injury requires urgent evaluation.

19️⃣ Can Eyelid Crease Change With Age?

Some mild cases may improve as the eye muscles develop, but most need medical intervention.

20️⃣ Does the Child Need Glasses After Surgery?

If the child has vision weakness or lazy eye, the doctor may recommend glasses to strengthen vision post-surgery.

21️⃣ Can Eyelid Crease Affect Appearance?

Yes, especially if the crease is deep or persistent, but it usually improves after surgery.

22️⃣ Is Eyelid Crease Linked to Neurological Problems?

In rare cases, it may be related to neurological or muscular issues, requiring thorough evaluation.

23️⃣ Can Eyelid Crease Cause Strabismus?

It can. Constantly lifting the eyelid may affect muscles, causing secondary strabismus.

24️⃣ Is Surgery Safe for Young Children?

Yes, with a specialized pediatric ophthalmologist, surgery is safe and usually yields excellent results.

25️⃣ Can Eyelid Crease Return After Surgery?

Rarely, but secondary correction may be needed if the muscles are weak or the cause is congenital.

26️⃣ Are Home Exercises Helpful?

Simple muscle exercises can help post-surgery but cannot replace surgery for severe cases.

27️⃣ Does Eyelid Crease Appear More in One Eye?

Most congenital creases appear in one eye, but both eyes may be affected depending on the cause.

28️⃣ Does Eyelid Crease Affect Sleep?

Usually no, but if the eyelid is very droopy, it may cause eye fatigue during the day.

29️⃣ How to Detect Eyelid Crease Early?

Regular check-ups with a pediatric ophthalmologist from birth are the best way to detect it early and prevent complications.

30️⃣ Is Eyelid Crease Related to Lower Eyelid Problems?

Eyelid crease usually affects the upper eyelid, but sometimes lower eyelid issues may accompany it and require evaluation.

Types of Eyelid Crease in Children and Infants

1️⃣ Congenital Eyelid Crease

Present from birth.
Often due to natural skull shape or eyelid muscles.
May affect one or both eyes.
Sometimes linked to genetic syndromes or other birth defects.

2️⃣ Acquired Eyelid Crease

Appears after birth as the child grows.
Causes include repeated eyelid inflammation, injuries, or muscular/neurological issues.

3️⃣ Unilateral Eyelid Crease

Appears in one eye only.
Usually indicates a specific cause such as a small tumor or muscle issue.

4️⃣ Bilateral Eyelid Crease

Present in both eyes.
More common in normal children or in genetic syndromes.

5️⃣ Subtle Eyelid Crease

Small fold or mild wrinkle.
Usually does not affect eye function or vision.

6️⃣ Pronounced or Deep Eyelid Crease

Large or deep fold altering the eyelid’s appearance.
May cause difficulty closing the eye, dryness, or cosmetic concerns.
Sometimes requires medical or surgical intervention depending on severity.

Symptoms of Eyelid Crease in Children and Infants

Visible symptoms:

Abnormal fold or crease, usually in the upper eyelid.
Eyelid asymmetry compared to the other eye.
Eye may appear smaller or uneven.

Associated symptoms:

Mild swelling or puffiness around the eyelid.
Redness or excessive tearing, especially if inflammatory.
Light sensitivity; child may squint or avoid bright light.
Limited eyelid movement; may not close completely or moves abnormally.

Severe symptoms requiring urgent evaluation:

Sudden increase in crease size or appearance after injury.
Severe swelling, redness, or discharge.
Difficulty opening or closing the eye.
Vision weakness or difficulty focusing.

Stages of Eyelid Crease in Children and Infants

1️⃣ Stage 1 – Mild crease:

Small fold, may be hard to notice.
No impact on vision.

2️⃣ Stage 2 – Noticeable crease:

Eyelid shape visibly changed.
Mild swelling or redness.
Possible light sensitivity or tearing.

3️⃣ Stage 3 – Associated symptoms:

Eyelid may not close completely.
Increased swelling or redness.
Minor effect on vision if covering the eye.

4️⃣ Stage 4 – Complications:

Eyelid crease causes eye hygiene issues or dryness.
Chronic irritation or recurrent eyelid/cornea infections.
Rarely affects vision without medical intervention.

5️⃣ Stage 5 – Critical stage:

Very deep crease or associated with complex congenital problems.
May require urgent surgical intervention to protect the eye.

⚠️ Risks of Eyelid Crease in Children and Infants

1️⃣ Difficulty closing the eye completely:

Deep creases may prevent full eye closure, causing dryness and irritation.

2️⃣ Eye dryness and irritation:

Partial closure leads to faster tear evaporation.
Redness, itching, and light sensitivity may occur.

3️⃣ Recurrent infections:

Exposed eyes are more vulnerable to dust, bacteria, and air, leading to conjunctivitis or chronic eyelid infections.

4️⃣ Impact on vision:

Very deep creases can press on the cornea or eye.
Delayed treatment may cause lazy eye (Amblyopia) or vision loss.

5️⃣ Cosmetic and aesthetic concerns:

Deep or uneven creases can affect eye and facial appearance.
Children may feel embarrassed or lose confidence as they grow.

6️⃣ Indications of congenital or medical problems:

Sometimes the crease indicates genetic syndromes or skull/eye defects.
Delayed diagnosis may prevent detection of other related health issues.

Diagnosis of Eyelid Crease in Children and Infants

1️⃣ Clinical Examination by a Pediatric Ophthalmologist

The first step is always a direct eye examination of the child.
The doctor checks the depth, location, and shape of the crease.
They determine whether the crease is persistent or temporary and if it affects eyelid movement or vision.

2️⃣ Evaluation of Eyelid Function

Monitor the child’s ability to fully close the eyelid.
Check for dryness or irritation caused by the crease.
Observe any abnormal movements of the eyelid or cornea.

3️⃣ Complete Eye Examination

Examine the cornea, conjunctiva, and iris to rule out scratches or infections.
Assess the impact on vision or amblyopia (lazy eye).

4️⃣ Imaging Tests (if needed)

In complex or deep cases, the doctor may order X-rays or MRI/CT scans.
Purpose: to rule out congenital anomalies or tumors behind the eye or in the orbit.

5️⃣ Hormonal or Gland Function Tests (rare)

If the crease is linked to congenital syndromes, thyroid or other hormonal tests may be requested.

⚠️ Important Advice:
Early diagnosis helps determine the type and severity of the eyelid crease.
Consulting a specialized pediatric ophthalmologist is essential to prevent complications like dry eye, infections, or vision problems.

Medical Treatment of Eyelid Crease in Children and Infants

1️⃣ Eye Drops and Moisturizers

Artificial tears to hydrate and protect the eye.
Topical eye moisturizers to reduce redness and itching.

2️⃣ Anti-Inflammatory Medications

NSAID eye drops for inflammation.
Sometimes mild steroid drops if inflammation is severe, under strict medical supervision.

3️⃣ Anti-Infective Medications

Antibiotic drops or ointments for bacterial infections.
Antiviral medications if the infection is viral.

4️⃣ Corneal Protection Medications

Protective ointment at night to prevent corneal dryness.
Reduces the risk of scratches or ulcers on the cornea.

⚠️ Key Notes:

Medications do not change the shape of the crease if it is congenital or structural.
They mainly relieve symptoms and protect the eye from complications.
Always under the supervision of a pediatric ophthalmologist to avoid misuse of drops or steroids.

Surgical and Laser Treatment of Eyelid Crease

1️⃣ Traditional Surgery (Surgical Correction)

Surgery is necessary if the crease:

Causes difficulty closing the eyelid or protects the cornea.
Is associated with clear congenital defects of the eyelid or orbit.
Leads to recurrent infections or corneal ulcers.

Types of Surgery:

Eyelid Crease Reconstruction:
- Reshapes the natural eyelid fold to correct or standardize the crease.
- Often used for congenital creases or structural problems.
Eyelid Lift Surgery (Blepharoplasty or Levator Surgery):
- Adjusts the levator muscle if the crease is associated with ptosis.
- Improves eyelid function and appearance.
Orbital or Canthal Surgery:
- If the crease is linked to problems with the eye corner or orbit.
- Restores a natural eye position and protects the cornea.

2️⃣ Laser Therapy

Suitable for small or superficial creases.
Helps improve skin appearance around the eye.
Reduces scarring or excess skin causing the crease.
Sometimes used after surgery to reduce swelling and improve cosmetic outcomes.

⚠️ Post-Surgery or Laser Advice:

Regular follow-ups to monitor healing and eyelid function.
Protect eyes from dryness using moisturizing drops.
Avoid rubbing or pressing the eyelid during recovery.
Monitor for redness or discharge and consult the doctor immediately if observed.
Protect eyes from sun and wind using sunglasses and hats.

Eyelid Crease Surgery Failure in Children and Infants

1️⃣ What is Surgical Failure?

The eyelid does not return to normal.
The crease reappears after surgery.
Eyelid function does not improve sufficiently.

2️⃣ Causes of Failure

Incomplete healing: weak skin or muscle repair causes instability.
Inappropriate surgical technique: mismatch between crease type and surgery method.
Post-operative infection: affects eyelid and reverses results.
Recurrent infections or corneal irritation: poor eyelid closure or tear issues.
Muscle problems or ptosis: weak levator muscle.
Child growth: eyelid changes as the child grows, especially if surgery was very early.

3️⃣ Signs of Surgical Failure

Persistent or recurrent crease after surgery.
Difficulty closing the eye completely.
Continuous dryness or irritation.
Uneven eyelids or noticeable difference between eyes.

4️⃣ Managing Surgical Failure

Immediate follow-up with a pediatric ophthalmologist.
Revision surgery: adjust the eyelid or muscles as needed.
Temporary use of moisturizing drops or corneal protection.
Ongoing monitoring of growth and development to ensure stability after secondary surgery.

Eyelid Exercises for Children and Infants

1️⃣ Purpose of Exercises

Strengthen the levator muscle.
Improve full eyelid closure.
Reduce eye dryness and irritation.
Improve coordination with the other eye.

2️⃣ Exercises Suitable for Older Children

For infants, exercises focus on stimulating the eyelid and eye muscles, as they cannot cooperate like older children.

Examples:

Eyelid Opening and Closing:
- Encourage the child to open and close the eye several times while playing or looking in the mirror.
- Strengthens the eyelid muscle.
Tracking Light or Toys:
- Move a toy or light in front of the child to follow.
- Stimulates eyelid movement with eye movement.
Gentle Touch Stimulation (for infants):
- Light touch around the eyelid or eye while cleaning the face.
- Helps muscles move naturally without pressure.

3️⃣ Important Notes

Exercises cannot correct severe congenital or muscular creases, but help improve movement and reduce complications.
Should be done under the supervision of a pediatric ophthalmologist.
After surgery, the doctor may recommend specific exercises for better recovery.
Stop exercises and consult the doctor if there is severe redness, persistent tearing, or difficulty closing the eye.