Ptosis (toe-sis) is a drooping of the upper eyelid. The lid may droop only slightly, or it may cover the pupil or eye entirely. Ptosis can affect one or both eyelids. In some cases, ptosis can restrict and even block normal vision.

Sometimes ptosis is present at birth; in other cases it occurs later in life due to injury or disease.

Ptosis is usually treated with surgery.

Signs and symptoms of ptosis

The most obvious sign of ptosis in children is the drooping lid itself. Your child may have:

• drooping of one or both eyelids
• increased tearing (watery eye/s)
• interference with their vision, if the ptosis is severe.

Children with ptosis often tip their heads back into a chin-up position to see underneath their eyelids, or they may raise their eyebrows in an attempt to lift up the lids. Over many years, abnormal head positions may cause deformities in the head and neck.

When to see a doctor

If you think your child has ptosis, take them to see your GP. You will be referred to an ophthalmologist (eye doctor).

Treatment for ptosis

If a child is born with moderate to severe ptosis, treatment is necessary to allow for normal vision development. If it is not corrected, a condition called amblyopia (lazy eye) may develop. Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. If left untreated, amblyopia can lead to permanent poor vision.

The treatment for childhood ptosis is usually surgery, although there are a few rare disorders which can be corrected with medications. The ophthalmologist will assess your child and determine whether or not surgery is needed, based on:

• your child's age
• whether one or both eyelids are involved
• measurement of the eyelid height
• the eyelid's lifting and closing muscle strength
• observation of the eye's movements.

During surgery, the levators (muscles which lift the eyelid), are tightened. In severe ptosis, when the levator is extremely weak, the lid can be attached or suspended from under the eyebrow so that the forehead muscles can do the lifting.

What causes ptosis?

Ptosis is also known as drooping eyelid, and it is caused by weakness of the muscles responsible for raising the eyelid, damage to the nerves that control those muscles, or loose skin of the upper eyelids.

Ptosis can be caused by a congenital abnormality (present at birth), or it can develop later due to an injury or disease. Ptosis that is present at birth is called congenital ptosis. Although it is usually an isolated problem, a child with congenital ptosis may also have:

• eye movement abnormalities
• muscular diseases
• eyelid tumours
• neurological disorders
• refractive errors (poor vision, e.g. short-sightedness or long-sightedness).

Key points to remember

• Ptosis can be present at birth or develop later due to injury or disease.
• If a drooping eyelid is left uncorrected in a child, it can lead to amblyopia (lazy eye). If amblyopia is not treated early in childhood, it can lead to permanent poor vision.
• Ptosis can be treated with surgery to improve vision as well as cosmetic appearance.

For more information

• Talk to your family GP, paediatrician or ophthalmologist.

Call an ambulance (000) immediately in an emergency.

Developed by The Royal Children's Hospital Ophthalmology department. We acknowledge the input of RCH consumers and carers.

Reviewed March 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.