Treatments

What are the Treatment Options?

• If not repaired, this condition will remain unchanged throughout life. Your child should undergo a complete ophthalmologic examination. Your ophthalmologist will evaluate your child's vision and refractive error (need for glasses) and examine the pupils and the motility or movement of the eyes. 
• Your doctor will measure the eyelid height and the eyelid's lifting and closing muscle strength. If the droop of the eyelid is severe enough to affect the child's vision, then early ptosis surgery may be indicated. If the child's vision is not affected, then the child will be closely monitored for changes in the condition.
• Congenital ptosis is treated surgically with the specific operation being based on the amount of ptosis and the strength of the levator (lifting) muscle. If the ptosis is mild to moderate, surgery will usually be performed when your child is school-aged (3-5 years old). If the ptosis interferes with your child's vision, surgery will be performed at an earlier age to allow proper visual system development and to prevent or minimize amblyopia.
• Congenital Ptosis is treated surgically, with the specific operation based on the severity of the Ptosis and the strength of the levator muscle.

• If the Ptosis is not severe, surgery is generally performed when the child is between 3 and 5 years of age (the "pre-school" years).

• However, when the Ptosis interferes with the child's vision, surgery is performed at an earlier age to allow proper visual development.

• Congenital Ptosis is most often treated by ophthalmic plastic and reconstructive surgeons who specialize in disease and conditions affecting the eyelids, lacrimal (tear) system, the orbit (bone cavity around the eye), and adjacent facial structures.
• Below are some pictures of a young child who developed a lazy eye from Ptosis and had surgery to repair the drooping left upper eyelid.

Surgical Techniques

• Conjunctival-Muellers resection
• Levator resection
• Frontalis sling

  The idea  of the frontalis sling procedure is to transfer the elevating function of the ptotic eyelid to the frontalis muscle. To achieve this, the eyelid is directly suspended to the brow using various materials. in older children with sufficient limb length, the sling material of choice is autogenous fascia lata Fascia (autogenous or donor using material such as B ioElevation T Ptosis Slings ) Silicone Supramid suture, Gortex, silicone, or Mersilene mesh may also be used. Because the sling material has little elasticity, a tethering effect on downgaze, Lagophthalmos are expected postoperatively

See a Video Clip of the  Ptosis Surgery
Dial UP Connection
Broadband (Cable/DSL)

• If your surgeon recommends the use of human tissue, the type of tissue commonly used is fascia lata. Fascia lata is a type of tissue or collagen located in an area of the human body adjacent to the thigh muscle, known as the ilio-tibial tract. The surgeon may use a fascia lata autograft or a fascia lata allograft. An autograft is tissue (in this case, fascia lata) obtained from the patient's own body through what surgeons' refer to as a 'secondary surgical site'. An allograft is tissue obtained from a human donor.
• Experts believe both autografts and allografts have advantages and disadvantages. Autograft procedures can lengthen the time you are under anesthesia, result in greater discomfort and longer recovery period. With very young children, autografting may not be an option. The fascia lata in young children is not developed enough for autografting. Some people believe that allografts carry other risks: potential infectious disease transmission and higher rate of graft absorption.
• The development of processed allografts (like Tutoplast®) has diminished many of the allograft risks. Science has been able to identify agents and compounds capable of destroying viruses, antigens and pathogens. Tissue processing technology has also developed ways to increase the survivability of donor tissue grafts in the human body.

Pre-operative	Post - operative
Intra-Operative photo, showing an external levator resection

Patients with Frontalis Sling; Before & After Photographs

.
A suture-tarsorrhaphy system is often used to elevate the lower eyelids to protect the cornea in the healing phase

This patient underwent bilateral frontalis slings with fascia (such as BioElevation T Ptosis Slings )

What can we expect following surgery?

• The main goals of ptosis surgery are (i). the elevation of the upper eyelid to permit normal visual development and (ii) the creation of a full field of vision and symmetry with the opposite upper eyelid.
• One day after surgery: Your child will be examined the day after surgery to assess vision, eyelid height and the incisions. You will be asked to keep the operative site clean and to place antibiotic ointment on the incisions several times per day.
• One to two weeks after surgery: One to two weeks after surgery, your child will typically be re-evaluated. Once again, vision, eyelid height and the incisions will again be assessed.
• Four to six weeks after surgery: It typically takes several weeks for the eyelid to reach its final or "settlement" height. If necessary, further adjustments can be made to improve eyelid placement. Many experts note that when operating on an abnormal muscle, completely normal, long-term eyelid position and function may not be possible to achieve.
• Children with congenital ptosis should be followed closely by your ophthalmologist, both before and after surgery. This will help ensure that their vision is developing properly.