Ptosis

What is ptosis?

Ptosis (say: TOE-sis) is when your child has a droopy eyelid or eyelids.

What causes ptosis?

Ptosis is caused by weakness of the muscle that lifts the upper eyelid. Children are usually born with ptosis. In a few cases, ptosis may be caused by an accident or a brain problem.

Ptosis
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A drooping upper eyelid is called Ptosis.

Your doctor may do tests to find out the cause of your child's ptosis or refer your child to other specialists for advice.

What can happen if your child has ptosis 

  • If the droopy eyelid interferes with your child's vision, amblyopia ("lazy eye") may occur.
  • Your child may have to tilt her head back to see from under the droopy lid(s).
  • A droopy eyelid may cause your child to look like she is sleepy, not paying attention, or not interested. Other people's reactions to your child's appearance may affect her self-image.

Treatment for ptosis

Your child will need surgery (an operation) if the ptosis affects her vision. Different types of surgeries can correct ptosis. Your doctor will discuss with you which surgery is best for your child and the risks involved with any surgery.

Eye Muscles: Side View
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The levator palpebrae superioris muscle is the muscle responsible for lifting the upper eyelid.

Surgery for ptosis

There is no single type of surgery for ptosis. Your doctor will explain what will happen during the surgery that is chosen for your child.

Before the surgery, your child will have a special "sleep medicine" called a general anaesthetic. This will make sure your child sleeps through the operation and does not feel any pain.

The operation is done as a day surgery. This means that your child will not stay in the hospital overnight afterwards.

What to expect after your child's surgery

Pain or discomfort

Your child may have some pain in the operated eye. Ask your child's doctor if you can give medicine to relieve the pain.

Eye patch

A patch is usually put on your child's affected eye after the surgery and removed the next day at home. Your doctor will tell you when to remove the patch.

Puffy eyelids and bruising

Your child's eyelids may be puffy, bruised, and swollen after the surgery.

Pink discharge or bleeding

Your child may have small amounts of slightly pinkish discharge or bleeding from the operated area for the first day. If this happens, you can stop the bleeding by gently wiping the operated area with a clean dressing and applying gentle pressure for a few minutes. Call your doctor if the discharge or bleeding continues or if the discharge becomes yellow or green.

Eyelid height

Your child's eyelid may still droop after the operation. It may take several weeks for your child's eyelid to reach its final height.

How to care for your child after ptosis surgery

Cool water compresses

Some doctors will suggest putting cool water or ice water compresses on the eyes to ease discomfort and reduce the swelling after surgery. Ask your child's doctor if your child can have cool compresses.

To make a cool compress, follow these steps:

  1. Always wash your hands before and after you touch your child's eyes.

  2. Fill a clean container with cool water. Cool tap water is fine. If you have well water, boil it and cool it in the refrigerator before you use it.

  3. Soak a clean face cloth in the water.

  4. Squeeze any extra water out of the cloth, then place the cloth on the swollen eye(s).

  5. Leave the cloth on for no more than 2 minutes at a time.

  6. Repeat a few times.

Ask the doctor how often your child can have a cool compress. Several times a day for the first 1 to 2 days is often fine.

Sleeping

If you can, try to let your child sleep with her head raised on one or two pillows. This will help to bring down any swelling and puffiness. For babies, toddlers, and pre-school children, put the pillows under the mattress to raise  the head of the bed.

Eye ointment and eye drops

Your child will need antibiotic ointment on the affected eye(s) and the stitched area several times a day. Make sure you get the prescription from the doctor and follow the instructions for applying the ointment.

Sometimes, your doctor will also order antibiotics or a combination of cortisone and antibiotic drops for the operated eye(s). If your child needs eye drops, your child's doctor will give you a prescription. It is very important to put in the eye drops correctly.

Gentle play only for the first week

For the first week after the surgery, light activities such as playing gently indoors, using computers, and watching TV are fine.

During this time, your child will need to avoid rough activities, sandbox play, or contact sports such as soccer, hockey, or anything else that would cause her to bump into another child.

Your child should also avoid bending and any activities that could cause her to get out of breath.

Ask your child's doctor when your child can return to normal activities. 

Baths and showers

Ask your child's doctor about baths and showers. Some doctors prefer your child to take a bath instead of a shower for the first week after surgery.

Please check with your child's doctor if it is ok to wash your child's hair, as the water could run over her eyes. If you can wash your child's hair, make sure you avoid getting soap or shampoo in her eyes.

Only wash your child's face with a clean face cloth and water.

School and day care

Generally, children should not go to school or day care for the first 1 or 2 days after the surgery, sometimes longer. Please check with your child's eye doctor. Tell your child's caregiver or teacher about any activities that your child must avoid while the eye heals.

Swimming

Generally, swimming is not allowed for at least 1 week after the surgery. Please ask your child's doctor when your child can return to swimming.

Sun exposure

Your child should avoid going out in the sun right after surgery. Check with the doctor when it is ok for your child go go back out in the sun.

Follow-up appointments

You will need to bring your child to a follow-up appointment, usually 1 to 2 weeks after the operation.

Write the date and time of the follow-up appointment here:

____________________________________________________________________

Sometimes, your child may need to have a second operation. The doctor will discuss this with you.

When to call the doctor

Please call the surgeon after the operation if:

  • your child cannot see properly
  • your child's pain gets worse
  • your child has a tummy upset
  • your child's eye suddenly gets more puffy
  • your child's eye  starts bleeding
  • there is any green or yellow discharge.

Write down your child's doctor's name and phone number here:

Name: __________________________________________

Phone number: ___________________________________

Key points

  • Ptosis is when your child has a droopy eyelid or eyelids.
  • Ptosis is caused by a weakness of the muscle that lifts the upper eyelid.
  • Your child's doctor will discuss which surgery is best for your child.
  • Pain medicine, antibiotics, and cool compresses will reduce pain, swelling, and the chance of an infection after the surgery.

Yasmin Shariff, RN

Robert C. Pashby, MD, FRCSC

Dan D. DeAngelis, MD, FRCSC

 

8/13/2012

At SickKids:

If the eye doctor who operated on your child's eye is not available, call 416-813-7500 and ask for the eye doctor on call.





Notes: