Congenital Ptosis (Droopy Eyelids in Infants, Toddlers, Children) Management, Surgery & Treatment (Cure):

  • Not all patients with congenital ptosis need surgical intervention.
  • But, the children need to be closely monitored for the possible development of occlusion amblyopia (lazy eye occurring due to visual deprivation by the droopy eyelids). Since amblyopia may not be reversed after age 7-10 years, appropriate and timely medical and surgical treatment of congenital ptosis is critical to preserve the child’s vision.
  • Uncorrected congenital ptosis can result in amblyopia secondary to deprivation or uncorrected astigmatism.
  • An abnormal eyelid position can have negative psychosocial effects. Children can be very cosmetically and socially aware and if peers treat them differently because of their drooping eyelids, the ptosis may have huge lifetime lasting, confidence damaging psychological impact.
  • Uncorrected acquired blepharoptosis results in decreased field of vision (superior) and frontal headaches.

General treatment

  • Early consultation with an oculoplastic surgeon, trained in both ophthalmology and plastic surgery, to avoid amblyopia.
    •Must be able to rule out and document other possible causes of ptosis (eg, Horner syndrome, third cranial nerve palsy), which may impact growth and other parts of the body’s development.

Medical therapy

Only observation is required in mild cases of congenital ptosis if no complications like signs of amblyopia, strabismus, and abnormal head posture are present.

  • Depending on the severity of the congenital ptosis, patients should be monitored every 3-12 months for signs of amblyopia due to congenital ptosis. External photographs can be helpful in monitoring patients.
    •Head posture should be carefully examined. If the patient acquires a chin-up posture due to the worsening of ptosis, surgery is indicated. Since the droopy upper eyelids block vision, the child raises the chin so as to see.
    •The patient should be checked for astigmatism (visual refractive errors requiring glasses for correction), due to the compression of the droopy eyelid.

Medical follow up

  • Patients who underwent surgery for congenital ptosis are initially monitored every 2-4 weeks for signs of exposure keratopathy, infection, granuloma formation, and overcorrection and undercorrection. External photographic documentation can be helpful in monitoring patients.
    •Following the surgery, visual acuity, head posture, and refractive error should be carefully monitored. Any residual amblyopia should be treated aggressively.

Patients with congenital ptosis may have other conditions that need to be addressed. These conditions include amblyopia, strabismus, craniofacial abnormalities, and other neurologic findings. Appropriate consultation may be needed depending on the associated findings.

  • Strabismologist (Squint & Amblyopia specialist)
  • Pediatric neurologist
  • Cardiologist (if mitochondrial disorder suspected)


Congenital ptosis has physical, functional, and psychological consequences.

  • The method of repair depends on treatment goals, the underlying diagnosis, and the degree of levator function. Although the primary reason for the repair is functional, the surgeon has an opportunity through this procedure to produce symmetry in lid height, contour, and eyelid crease for better cosmesis. A good eyelid surgeon understands that ptosis correction has to have a cosmetic (aesthetic) thought process – When a child looks at the world, the world looks at their eyes – And, so, the eyes must look the same and beautiful, post surgery.
  • Surgical correction of congenital ptosis can be undertaken at any age depending on the severity of the disease. Earlier intervention may be required if significant amblyopia or ocular torticollis is present.


Types of Surgery for Congenital ptosis (Droopy eyelids in children):


Levator muscle resection


◦This procedure is the shortening of the levator-aponeurosis complex (muscle responsible for raising the eyelid) through a lid-crease incision. The skin incision is hidden either in the existing lid fold or in a new lid fold created to match that of the contralateral eyelid.
Tarso-Frontalis suspension procedure
◦This procedure is designed to augment the patient’s lid elevation through brow elevation. This surgery is performed in those children in which the levator muscle (muscle responsible for raising the eyelid) is very weak. The eyelid is suspended from the frontalis muscle (muscle over the eyebrow), to allow the frontalis muscle to take over the function of the levator muscle and raise the drooping eyelid.

◦ Surgical technique: Several materials are available to secure the lids to the frontalis muscles.10,11,12,13 These materials include:

  • Silicone bands, silicone rods
  • Autogenous fascia lata: Autogenous fascia lata can be obtained from the leg of patients older than 3 years. This surgery is now almost never performed, because of the morbidity associated with a huge leg incision and surgery to harvest the tissue.
  • Preserved (tissue bank) fascia lata
  • Nonabsorbable suture material (eg, 2-0 Prolene, Nylon (Supramid) or Mersilene)
  • ePTFE (expanded Poly Tetra Fluoro Ethylene), Gore-Tex
  • Autogenous materials used less frequently include palmaris longus tendon and temporalis fascia.

◦Surgical outcome: Patients may not be able to close their eyelids during sleep from a few weeks to several months following surgery. Families must be warned of this outcome before the operation. The problem of open lids during sleep improves with time; however, aggressive lubrication is needed to avoid exposure keratopathy.

Fasanella-Servat procedure

◦The upper lid is elevated by removing a block of tissue from the underside (red, conjunctival eyelid surface) of the lid. This tissue includes the tarsus, conjunctiva, and Müller muscle.
◦This procedure is not commonly performed for cases of congenital ptosis.

Müller muscle–conjunctival resection

◦This surgery is chosen if the eyelid has had a good response to phenylephrine (a medicine which causes papillary dilatation).
◦The conjunctiva and the Müller muscle are marked off, clamped, and sutured. The tissues are resected. Then, the conjunctival layer is closed.
◦This procedure is not commonly performed for cases of congenital ptosis.


 Results & Prognosis post surgery for congenital ptosis:

  • The repair of congenital ptosis can produce excellent functional and cosmetic results.
    •With careful observation and treatment, amblyopia can be treated successfully.
    •Of patients who require surgical intervention, 50% or more may require repeat surgery in 8-10 years following the initial surgery, as the child becomes older and acquires adult facial features.

To see the video of a child with congenital ptosis in whom eyelid surgery was performed by Dr. Debraj Shome:

Best Child Droopy Eyes Surgery | Congenital Ptosis Eyelid Treatment in Mumbai, India

Blepharoptosis or Ptosis or drooping upper eyelid is a common eyelid disease, Ptosis can affect one eye or both eyes. Ptosis describes an abnormally low upper eyelid, resulting in a very sleepy eyed l…

To read more on Congenital droopy eyes surgery treatment, read Dr. Debraj Shome’s blog: