1. Prevention of lazy eye or amblyopia and strabismus or squint.
2. Improved appearance will improve the child’s self-confidence, especially if being teased at school
3. Restoration of a normal anatomical position of the eyelid.
4. Restoration of the normal cosmetic appearance of the eyelid.

1. Bruising of the eyelids and around the eye.
2. A small risk of infection of the eyelid or the eye.
3. The possibility of under-correction or over-correction of the eyelid height, requiring a second operation.
4. Unable to close the eyelid completely, with the eye slightly open at night. This is usually not a problem and the parents should be warned of this. There is a strong protective reflex, called Bell’s phenomena, which protects the surface of the eye on blinking and eyelid closure so that as long as the muscle that closes the eyelid is strong, there is no risk to vision.

The wound should be kept clean and dry and there should not be any discharge. There will be a bit of swelling and redness of the eyelid for the first 1 to 3 weeks. The child will be prescribed lubricating antibiotic eye drops and cream, to be used as directed.

A frontalis sling, or brow suspension, is where the muscle of the forehead (frontalis muscle) is used to help lift the eyelid by placing a sling of material, either taken from the child or synthetic, between the forehead and the eyelid. Tissue taken from the child is called autogenous fascia lata and is a small strip of tendon taken from the leg through a 1 cm incision just above the knee, on the side of the leg. If the child is too young to have this done, and a sling or brow suspension is required before the age of 4 years, synethetic material, such as silicone, or prolene, or gortex, may be used instead.

Surgery can be done as in an adult, involving a small skin incision into the skin crease of the upper eyelid or, if the levator palpebrae superioris is extremely weak, it may be necessary to do a sling operation

Ptosis surgery on a child is done under general anaesthetic, usually as a day case. An eye patch is rarely put on and the stitches, or sutures, on the skin are dissolvable.

Congenital ptosis is treated surgically and the operation is based on the individual child’s severity of ptosis and the strength of the levator palpebrae superioris muscle. If the ptosis is not severe, surgery can be deferred until the child is aged 3 or 5 years i.e. the pre-school years. However, if the ptosis is interfering with the child’s vision, surgery may be performed at a much earlier age, even as young as 3 weeks, to allow proper visual development.

Children with congenital ptosis may also have an amblyopic or lazy eye, strabismus or squint (eyes that are not properly aligned or straight), or refractive error (need for glasses). Therefore all children with ptosis should have a thorough examination by an orthoptist for visual development, with a refraction by the oculoplastic surgeon and eye and eyelid measurements.

This is drooping of the eyelid, affecting one or both eyes, present since birth.

1. Improved upper part of your visual field and quality of vision, where part of the eye was previously covered by the upper eyelid drooping and interfering with visual function.
2. Restoring the normal anatomical appearance of the eyelid.
3. Improved cosmesis and symmetry.

1. Local bruising and swelling of the eyelids.
2. A small risk of wound infection to the eyelid.
3. Risk of over-correction (eyelid too high), or under-correction (eyelid still too low) which may require a second operation.
4. Inability to close the eyelids completely, which may be temporary or permanent. This requires lubricant drops and ointment. If it is permanent and threatens the vision, then the eyelid will have to be subsequently lowered again to protect the eye.
5. Sometimes if the other eye has a tendency to drop, this may become more noticeable after ptosis surgery on one side. Your oculoplastic specialist will warn you of this possibility.

An eye pad may be applied for 24 to 48 hours. The upper eyelid will usually appear swollen for the first 7 to 10 days. The wound should be kept clean and dry and there should be no discharge from the wound. Instructions will be given on how to clean the wound daily and lubricating and antibiotic drops, or ointment, prescribed for 1 to 3 weeks.

Eyelid ptosis surgery is usually done under local anaesthesia as a day case. Local anaesthetic drops are placed on the eye and a small bleb of local anaesthetic is given into the upper eyelid to numb the area. A short incision is made in the natural skin crease and the eyelid raising muscle (the levator palpebrae superioris) is identified and shortened to lift the eyelid. Dissolving sutures are used inside the lid and on the skin.

Congenital (present since birth) due to a poorly developed muscle. It is more common in older adults where the muscle that lifts the eyelid thins and the eyelid drops. It occurs with age, contact lens wear, trauma and, rarely, tumour or from a neurological problem, such as a nerve palsy or muscle weakness (myopathy).

It is a droopy upper eyelid. If the lid edge displaces downwards it can cover part of the pupil and block the upper part of the vision, or cause fatigue. In severe ptosis patients have to tilt their head back, or lift the eyelid with a finger, in order to see out well. These are functional problems. Mild ptosis can be a cosmetic problem.

1. Complete relief of symptoms of tearing, crusting, mucous discharge, foreign body sensation, irritation and blurred, impaired vision.
2. Reduction of the risk of eye infection and restoration of the normal position and appearance of the eyelid.

1. Bruising around the eyelids and on the eye.
2. Infection of the eyelid or eye.
3. Recurrence or over-correction of the eyelid, resulting in it turning outwards, requiring further operation.
4. Allergic reaction to the local anaesthetic injection, or the antibiotic ointment or drops.

Surgery for entropion is usually done under local anaesthesia, as an out-patient. The oculoplastic surgeon will tighten the eyelid and its attachments, which can be done by either some simple sutures, or stitches, placed through the lower eyelid, or sutures plus eyelid tightening and stabilisation with a lateral tarsal strip. You may have an eyepad overnight and then will put in antibiotic drops or ointment for one to three weeks. After the eyelid has healed, the eye should feel comfortable, the eyelid be in a normal position and there will no longer be any risk of corneal scarring, infection or loss of vision.

Temporary relief of entropion can be by taping of the eyelid outwards, putting in comforting lubricant drops, or temporarily paralysing the muscle that turns the eyelid in (orbicularis muscle) with a tiny injection of Botox, or Botulinum Toxin A, to the muscle of the lower lid. In the long term, surgery is recommended to prevent rubbing damage of the eyelid skin and lashes on the front of the eye, by reducing infection and risk of scarring.

Most commonly entropion is due to relaxation of the tissue in the eyelid as a result of ageing. It can be caused occasionally by scarring of the inner surface of the eyelid from chemical or thermal burns of inflammatory diseases, such as ocular pemphigoid or allergic reactions.

Entropion is inward turning of the lower eyelid, resulting in the eyelashes directing towards the surface of the eye, causing discomfort. The skin of the eyelid and the eyelashes may rub against the cornea (front part of the eye) and the conjunctiva (the white mucous membrane that protects the surface of the eye). Rubbing of the eyelid skin and lashes against the eye can result in excess tearing, crusting of the eyelid, mucous discharge, foreign body sensation, irritation of the cornea and impaired vision from keratitis.

1. Relief of symptoms, particularly watering and irritation.
2. Correction of anatomical position of eyelid, with restoration of normal appearance of eyelid.
3. Reduction of risk of eye infection and exposure.

1. Bruising of eyelid.
2. Bruising of eye.
3. Infection of the eyelid or eye.
4. Recurrence or over-correction of the eyelid position, requiring further operation.
5. Allergic reaction to the local anaesthetic or antibiotics drop or ointment.

Ectropion surgery is done by an oculoplastic surgeon, under local anesthesia, as an out-patient. In most cases, the oculoplastic surgeon will tighten the eyelid and its attachments to put the eyelid back in the normal anatomical position. This may require an overnight eye pad, followed by installation of antibiotic drops, or ointment, into the eye for one to three weeks. This is not a painful operation and you can return to work, or normal activities, within about four days. Whilst the eyelid is healing, the eye may feel a little gritty and ache at the corner, but after it has healed the eye will feel comfortable and there will no longer be symptoms of tearing, crusting, mucous discharge, irritation or redness.

Ectropion symptoms can occasionally be relieved temporarily with ointment but should be repaired surgically. The aim of surgery is to reduce the symptoms of tearing, crusting, discharge, irritation, and redness of the eyelid, +/- the eye’s surface.

Most cases of ectropion are due to simple laxity of the eyelid as a result of ageing. In some cases scarring of the eyelid skin, caused by chemical or thermal burns, trauma, or mechanical effect from skin cancers, or previous eyelid surgery, can result in the eyelid turning outwards, away from the eye.

Ectropion of the lower eyelid is sagging and outward turning of the eyelid margin and eyelashes away from the eye. This can lead to excess tearing, crusting of the eyelid, mucous discharge, irritation of the eye and redness of the eyelid.