The following pre-referral guideline covers droop eye lid (ptosis). Please see other ophthalmology guidelines as appropriate.

This guideline has not yet had a GP working group review.  We appreciate your  feedback.

See resources for referral form, parent information and more.

Recommended pre-referral assessment/treatment

Please check the following:

1. Assess ptosis - is the eyelid covering all of or any part of the pupil? (See diagram)
2. Check visual acuity if child is of an appropriate age. If the child is too young to check visual acuity, ascertain whether the child can fix and follow - for toddlers, try a toy and for infants try a toy or a light.
3. Check ocular motility - whilst holding the eyelids up ask the child to look at the ceiling, down at the floor and side-to-side. If child is too young, again try a toy or a light.
4. Perform fundus examination and note presence/absence of red and white reflex.
5. Assess pupillary reactions and sizes.

Findings and when to refer

Neonates

• If normal, re-assess in 2 months. 

• If assessment results are abnormal or if ptosis persists past 2 months of age
  • Immediate Referral
    

    Fax to 03 9345 5034 and call 03 9345 6180 to note urgent referral.
    

Older infant and child

• Droopy eyelid obstructing vision (moderate to severe)
  • Immediate Referral
    Fax to 03 9345 5034, also call 03 9345 6180 to note urgent referral.
    

• Sudden onset of droopy eyelid
  • Immediate Referral
    Fax to 03 9345 5034, also call 03 9345 6180 to note urgent referral.
    

• Any child with a droopy eyelid that does not obstruct the pupil (mild)
  • Refer semi-urgently.
    

• Older child (age 9 years +) with history of congenital droopy eyelid
  • Refer non-urgently for evaluation.

Contact information

Resources

• RCH OPD referral form (word)
• Generic parent handout (about RCH pre-referral guidelines)
• Kids Health Info - parent information website
• Ptosis - parent fact sheet
• Kids Connect (Primary Care Liaison) www.rch.org.au/kidsconnect
  Contains all referral forms, clinic information, other pre-referral guidelines and parent information.
• Feedback
  Please give feedback on this guideline - kids.connect@rch.org.au  telephone: (03) 9345 4645 / fax (03) 9345 4650

References: Paediatric Handbook (2009). Eye Conditions, Chapter 23 (pp357-368). James Elder and Peter Barnett. 8th Ed, Blackwell Publishing by the Staff of the Royal Children's Hospital, Melbourne. Australia.

Last updated

Last update: August 2011

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