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Ptosis Redo


Question

Seeking a second opinion in regard to son, age 16, who first had surgery for Ptosis at age five. Mom feels that he needs to have the surgery redone. He is exhibiting behaviors of eye poking and pushing at his eyelids. His physician is of the opinion that the behaviors are self-stimulating and that surgery is risky because any poking or pushing at the eye in the two-week period following surgery could result in long-term damage, even blindness. Mother feels that the benefits outweigh the risks. Can you comment?

Answer of our experts

The indications for Ptosis surgery are two-fold: Eyelids that are droopy to the point that they obstruct vision or that the child has to lift her/his chin so much to see under the lids that it impairs the ability to walk. This is easy to determine by the eye doctor

Cosmetically unacceptable appearance. This is a parental decision

If the doctor feels that #1 is not satisfied, then surgery is not needed unless parents choose surgery for reason #2

The symptom you describe (eye poking) is not a sign that the eyelids need to have surgery. Lid pushing can be a sign if the child is specifically lifting their upper lid (I have seen kids with CdLS do this) to see. This is usually obvious as the child will hold the lid up specifically to accomplish a visual task (not random lid lifting)

The doctor is absolutely correct that eye poking could be very harmful in the immediate postoperative period. If the wounds were to open you would have a much worse problem on your hands. However, if surgery is absolutely necessary, a helmet with eye visor can be worn while things are healing

AL/TK 7-13-10

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Recommendation(s)

The eyes and the visual system

R36
Surgical correction of ptosis should be considered if vision is significantly affected or if the individual is lifting their chin in attempt to see more clearly and it is affecting the individual’s ability to move around.
R37
Blepharitis in individuals with CdLS should be treated conservatively with lid hygiene. Nasolacrimal duct obstruction (blocked tear ducts) should be suspected if symptoms are not improved with lid hygiene.
R38
Vision should be regularly evaluated in all individuals with CdLS, especially in infancy and childhood. Problems with vision should be corrected early to prevent amblyopia (lazy eye), although children may have difficulty tolerating glasses or contact lenses.

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Please take note that the Ask the Expert service is comprised of volunteer professionals in various areas of focus. Answers are not considered a medical, behavioral, or educational consultation. Ask the Expert is not a substitute for the care and attention your child’s personal physician, psychologist, educational consultant, or social worker can deliver.

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