Blepharoptosis syndrome in children causes types and treatment methods

Ptosis (Eyelid Drooping) in Children is a rare but important condition for parents to know about. It causes difficulty in opening the eye or reduced eyelid movement, which can affect vision or lead to cosmetic concerns for the child. we’ll explore the causes of ptosis, its symptoms, types, stages, and how it’s diagnosed. We’ll also cover treatment options, including medications, surgery, and exercises, as well as practical tips for supporting your child safely and effectively in daily life. Reading this article will help you understand the condition and provide your child with informed, safe, and supportive care.

What is Ptosis (Eyelid Drooping) in Children?
Ptosis is a condition that causes the upper eyelid to droop or contract, either constantly or intermittently. This can sometimes affect the appearance of the eye or the child’s normal vision.

Is it dangerous?
Most cases are not medically serious, but ptosis can affect the eye’s appearance or the child’s self-confidence.
In rare cases, severe drooping can lead to vision problems such as amblyopia (lazy eye) or double vision.

Can it improve with age?
Ptosis usually does not resolve on its own, as it’s linked to specific muscles or nerves.
However, mild cases may improve with exercises or surgical intervention.

Does eyelid drooping affect talking or eating?
In severe cases, the child may find it difficult to open the eye while talking or eating, but this is uncommon.

Is it hereditary?
Some congenital cases may have a minor genetic factor, but most cases occur individually and are not inherited.

When should you see a doctor immediately?

If there is sudden worsening of the eyelid drooping.
If any vision problems, severe headaches, or neurological signs appear.
If the eye shape changes significantly, affecting the child’s vision or daily activities.

What are the expectations for the child?
Most children with ptosis live normal lives with regular medical follow-up.
Surgery or exercises can significantly improve eyelid appearance and function.

Is nutrition important?
Yes. A balanced diet rich in Vitamin B12, Omega-3, and zinc supports the health of muscles and nerves.

Can ptosis appear suddenly?
Yes, in some cases, especially after an injury or surgery, but most cases are present from birth.

Is uneven eyelid height temporary?
Sometimes mild differences appear in early stages, but usually it persists unless corrected surgically.

Does ptosis affect facial expressions?
Yes, eyelid movement can make facial expressions less coordinated during eating or talking.
Exercises or surgery can help improve muscle control.

Stages of Ptosis in Children

Ptosis doesn’t follow strict disease stages but can be categorized by severity and impact on vision and daily life:

1️⃣ Early Stage / Infant Stage

Usually appears from birth or within the first year.
Upper eyelid slightly droops on one side.
Mild drooping, often unnoticed by parents without careful examination.
Rarely affects vision significantly, but follow-up is needed to prevent amblyopia.

2️⃣ Childhood Stage / Moderate Stage

Drooping becomes more noticeable as the child grows, especially when looking up or focusing.
Differences in eye appearance may be noticed.
Can cause mild psychological distress or reduced self-confidence in older children.
May require surgery or physiotherapy if drooping affects vision or appearance.

3️⃣ Severe Stage / Advanced Stage

Drooping is very noticeable even at rest.
Can cover part of the cornea, increasing the risk of amblyopia.
Difference between eyes is obvious.
Often requires urgent surgical evaluation to preserve vision and appearance.

Important Notes:

Most cases do not gradually worsen, but symptoms can appear or become clearer as the child grows.
Early diagnosis and follow-up with a pediatric ophthalmologist are essential for deciding on surgery or exercises.
Most children live normal lives unless drooping is severe and affects vision or appearance.

Causes of Ptosis in Children

Ptosis is often related to problems with the muscles or nerves that lift the eyelid. Common causes include:

1️⃣ Congenital Causes

Abnormality in the levator muscle (weak or short muscle).
Nerve problems such as facial nerve (VII) or oculomotor nerve (III) issues.
Most cases appear at birth and usually affect one eye.

2️⃣ Birth-related Causes

Nerve or muscle injury during delivery, especially long labors or use of forceps/suction.
Pressure on facial nerves during birth can cause partial or complete drooping.

3️⃣ Acquired Neuromuscular Causes

Neurological disorders like oculomotor nerve issues or muscle diseases.
Muscle or nerve inflammation after injury or infection (rare).

4️⃣ Associated Syndromes or Conditions

Some children have rare congenital syndromes affecting the eyes or face, e.g., Marcus Gunn Jaw-Winking syndrome.
Occasionally, drooping is linked to rare gland or tissue problems around the eye.

Symptoms of Ptosis in Children

The symptoms of ptosis (eyelid drooping) vary depending on the severity and cause, but generally include:

1️⃣ Eyelid Drooping (Ptosis)

The upper eyelid is partially or fully lowered on the affected eye.
Usually affects one eye, but sometimes can be bilateral.
In severe cases, the eyelid may cover part of the pupil, affecting vision.

2️⃣ Vision Problems

Reduced vision or amblyopia (lazy eye) if the eyelid covers the cornea for long periods.
Occasional double vision (diplopia).
Eye strain from the child constantly trying to lift the eyelid.

3️⃣ Uneven Facial Expressions

Noticeable difference between eyes during smiling or talking.
Sometimes difficulty controlling facial expressions due to weak muscles around the eye.

4️⃣ Associated Symptoms in Certain Cases

Abnormal eyelid movement when moving the jaw, as in Marcus Gunn Jaw-Winking Syndrome.
Fatigue when focusing visually for long periods.
Psychological or social issues, especially in older children, due to differences in eye appearance.

Important Notes:

Most children live normal lives if the drooping is mild.
Early diagnosis by a pediatric ophthalmologist is essential to assess severity and the need for surgery, exercises, or vision follow-up.

Risks of Ptosis in Children

The risks depend on the severity and cause of the drooping:

1️⃣ Vision Problems

Amblyopia (Lazy Eye): If the eyelid constantly covers the cornea, the affected eye may not develop normally.
Reduced Vision: Severe drooping limits the visual field and affects concentration.
Double Vision (Diplopia): Rare, but may occur in some neurological or muscular cases.

2️⃣ Impact on Eye Development and Head Posture

Constant tilting of the head upward to see better can cause neck and shoulder pain in older children.

3️⃣ Psychological and Social Impact

Differences in eye shape or eyelid opening may cause embarrassment in front of peers.
Reduced self-confidence or social anxiety, especially in older children.

4️⃣ Muscle and Facial Expression Issues

Difficulty controlling facial expressions due to weak muscles around the eyes.
Muscle fatigue from trying to lift the eyelid constantly.

5️⃣ Rare Complications

Problems in eye and jaw muscles in some neurological or congenital cases.
Urgent surgical intervention may be needed if drooping severely affects vision or social adaptation.

Important Note:

Most children live normal lives if the drooping is mild to moderate.
Early diagnosis is crucial to prevent lazy eye and other vision problems.

Types of Ptosis in Children

Ptosis can be classified based on cause and severity, which helps determine the appropriate treatment:

1️⃣ Congenital Ptosis

Present at birth or within the first year.
Caused by weakness or abnormality in the levator muscle.
Usually affects one eye.
Can be mild or severe and may require surgery if vision or eye appearance is affected.

2️⃣ Acquired Ptosis

Appears after birth, at any age.
Causes: injuries, infections, tumors, or nerve problems affecting the eyelid.
Sometimes temporary; may require surgery depending on the cause.

3️⃣ Neurogenic Ptosis

Caused by nerve problems controlling the eyelid muscles, such as oculomotor nerve issues.
May be accompanied by other symptoms, like double vision or drooping in the other eye.

4️⃣ Myogenic Ptosis

Due to weakness or abnormality in the eyelid muscle itself without nerve involvement.
Examples: Horner’s syndrome with pupil shrinkage, some hereditary or acquired muscle diseases.

5️⃣ Mechanical Ptosis

Caused by a mass or extra weight on the eyelid preventing normal elevation.
Examples: small tumors, cysts, or scars from previous injuries.

6️⃣ Functional or Pseudoptosis

Eyelid appears low but is normal on careful examination.
Usually due to psychological factors or excessive eye movement compensating for vision problems.
Often requires visual and psychological evaluation rather than surgery.

Diagnosis of Ptosis in Children

Diagnosis mainly depends on careful clinical examination, sometimes supported by additional tests:

1️⃣ Clinical Examination

Observe drooping: partial or complete, in one or both eyes.
Check eyelid movement while looking up, down, or moving the head.
Assess severity to determine impact on vision.

2️⃣ Medical History

Onset of drooping (congenital or later).
Previous injuries or surgeries.
Family history of eye or neurological disorders.

3️⃣ Visual Tests

Vision test to rule out amblyopia.
Visual field assessment to check if the eyelid covers part of the cornea.

4️⃣ Additional Tests (if needed)

EMG to evaluate the muscles and nerve controlling eyelid movement.
MRI or CT if congenital anomalies or neurological problems are suspected.

5️⃣ Differential Diagnosis

Distinguish between simple congenital ptosis and other causes, such as muscle weakness or nerve disorders.

Note:

Diagnosis is usually clear from clinical examination.
Early detection is important to determine the need for surgery or vision monitoring.

Treatment of Ptosis in Children

1️⃣ Medication

Very limited, as most cases are due to congenital muscle or nerve abnormalities.
Used only for complications:
- Amblyopia (lazy eye): patching the healthy eye or corrective glasses.
- Secondary eye inflammation: lubricating drops or mild anti-inflammatory eye drops.
- In rare cases, temporary eyelid muscle stimulants, but not a permanent solution.

Note: Most children do not need medication; focus is on vision monitoring.

2️⃣ Surgical Treatment

Surgery is usually recommended if the drooping affects vision or appearance:

A. Levator Muscle Resection (Levator Resection Surgery)

Goal: Reduce eyelid drooping and improve appearance.
Method: Remove or adjust part of the levator muscle.
Anesthesia: General anesthesia for children.
Notes: Suitable for mild to moderate drooping; may require adjustment later.

B. Frontalis Sling Surgery

Goal: Control severe eyelid drooping or if levator surgery fails.
Method: Connect the eyelid to the forehead muscle using a strip or synthetic material, so the eyelid moves with forehead movement.
Notes: Often for older children; improves symmetry and reduces involuntary movement.

C. Secondary Surgery or Muscle Adjustment

Goal: Improve symmetry between the eyes after the first surgery.
Notes: May be needed 6–12 months later depending on the child’s response.

Post-Surgery Tips

Regular follow-up with a pediatric ophthalmologist.
Protect the eye from infections and dryness.
Avoid activities that may injure the eye or eyelid during the first few weeks.
Follow all doctor’s instructions regarding stitches and eyelid care.

Exercise Therapy for Ptosis in Children

Exercises are not a definitive cure for ptosis, but they are very important because they:

Strengthen the muscles around the eyelid.
Improve coordination between the eye and eyelid muscles.

1️⃣ Levator Muscle Strengthening Exercises

Goal: Increase eyelid lifting ability and reduce drooping.
Method:
- Gently place a finger on the affected eyelid.
- Ask the child to lift the eyelid slowly against the resistance of your finger.
Repetitions: 5–10 times per session, twice daily.
Notes: Suitable for older children; ideally under the supervision of an eye physiotherapist.

2️⃣ Eye-Movement Coordination Exercises

Goal: Improve coordination between eye and jaw/face movement.
Method:
- The child slowly closes their mouth, then lifts the affected eyelid with focus.
- Gradually integrate facial or jaw movements.
Benefit: Trains the child to control eyelid movement and reduce involuntary drooping.

3️⃣ Facial Exercises

Goal: Strengthen facial muscles and improve symmetry.
Method:
- Gradual smile: gently lift the corner of the affected side of the mouth.
- Gentle movements of eyebrows, mouth, and jaw.
Repetitions: 5–10 times per exercise, twice daily.

4️⃣ General Muscle Control Exercises

Goal: Improve neck and shoulder strength to reduce fatigue.
Method:
- Light activities like raising arms, slow neck rotations, or simple shoulder movements.
- Can incorporate play-based movements to encourage activity.

5️⃣ Visual Function Stimulation

Goal: Strengthen communication between the eye and brain and improve visual focus.
Method:
- Visual games, e.g., tracking a moving ball or fingers.
Benefit: Reduces eye strain and improves concentration.

⚠️ Important Notes

All exercises should be done under supervision of an eye physiotherapist or pediatric neurologist.
Exercises improve muscle movement but do not treat nerve problems directly.
Monitor the child’s response and adjust exercises based on ability.
Exercises can be combined with surgical or medical treatment depending on severity.

Tips for Managing Ptosis in Children

1️⃣ Regular Medical Follow-Up

Monitor the child regularly with a pediatric ophthalmologist or neurologist.
Periodic check-ups help detect any changes in eyelid movement or vision.
Consult the doctor immediately if any sudden changes or new symptoms appear.

2️⃣ Eye and Eyelid Care

Continuously observe and record eyelid movement.
Protect eyes from strong light using sunglasses if the child is light-sensitive.
Avoid activities that may overly strain the eye or eyelid.

3️⃣ Support Muscle Movement

Encourage the child to perform simple eye and eyelid exercises under professional supervision.
Improve coordination between eye and eyelid to reduce fatigue and enhance facial expressions.
Include facial exercises like gradual smiles and gentle eyebrow/mouth movements.

4️⃣ Healthy Nutrition

Balanced meals to support nerve and muscle health.
Focus on foods rich in:
- Vitamin B12 – supports nerve health.
- Omega-3 – supports brain and nerve function.
- Zinc – improves muscle and nerve function.

5️⃣ Infection Prevention

Wash hands regularly to reduce infection risk.
Avoid direct contact with sick children, especially after surgery or medical treatment.

6️⃣ Psychological and Social Support

Support the child emotionally to reduce anxiety or embarrassment about eyelid appearance.
Encourage participation in school and group play activities as much as possible.
Educate family and friends gently about the condition to avoid teasing or embarrassment.

7️⃣ Monitor New Symptoms

Any change in facial expressions, eyelid movement, severe headache, or muscle weakness requires urgent medical consultation.
Prompt action reduces complications and improves treatment outcomes.

8️⃣ Integrating Treatments

Exercises can be combined with medical or surgical treatment if needed.
Regular follow-up with doctors ensures the treatment plan is adjusted according to the child’s response.