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Neonatal Ptosis: Should it be addressed at an Early Stage?
neonatal ptosis should be addressed at an early age

Neonatal Ptosis: Should it be addressed at an Early Stage?

Ptosis is a condition of the eye which makes the eye droop and when this occurs from birth, it is referred to as Neonatal Ptosis. The presence of ptosis in the neonatal stage might not be a regular occurrence, however, medical intervention at different stages of life can help to improve and correct related vision concerns.

In this article, we will address what neonatal ptosis is all about and answer the question of whether it should be addressed at the neonatal stage. At the end of this post, you will know everything you need to know about ptosis; from causes to signs and symptoms, treatment, and how parents can help and more.

What is Neonatal Ptosis?

According to the American Association for Pediatric Ophthalmology and Strabismus, ptosis, also called droopy eyelid, happens when the muscle that elevates the eyelid (the levator palpebrae superioris muscle) is weak. When this happens it causes drooping of the upper eyelid.

This condition can be a symptom of another medical condition or it can also occur by itself. The condition can be seen in individuals of all ages and can occur in one or both eyes. An eyelid drooping that occurs from birth or within the first years of birth is called congenital or neonatal ptosis.

One of the specific consequences of this condition at a young age can be the onset of amblyopia, commonly called ‘lazy eye.’

What causes Ptosis in Young Children?

Neonatal ptosis is often caused by a problem with the muscle that raises the eyelid. It can also be caused when there is a problem with the nerve that controls the eye or the upper eyelid muscle.

Comprehensively; congenital ptosis may occur due to any of these reasons;

  • An issue with the muscle that raises the eyelid
  • The nerve supplying the eyelid muscle
  • Trauma at birth
  • Eye movement disorders
  • Eyelid tumors or growth
  • Brain and nervous system problems

Note that ptosis that occurs later in childhood or adulthood is referred to as acquired ptosis and is caused by other factors like;

  • Advances ageing
  • Trauma
  • Muscle diseases or
  • Neurological disorders

Could Neonatal Ptosis have been prevented?

Neonatal ptosis cannot be prevented. However, it can be corrected with the appropriate treatment when if identified early.

Note that when the condition is not treated timely, it can lead to;

  • The child’s visual development impairment which causes conditions like amblyopia (lazy eye), blurred vision and strabismus.
  • The tendon attaching the levator muscle to the eyelid to weaken and overstretch. This results in a drooping eyelid and a major obstruction in the child’s pupil.

identifying signs and symptoms of ptosis in your childIdentifying Signs and Symptoms of Ptosis in your Child

It is crucial to know the signs and symptoms of neonatal ptosis and how to identify them in your child.

As a parent or guardian, your child may have congenital ptosis if they;

  • Say they have trouble seeing
  • Tilt their head back to see better
  • Run into things hanging from overhead, when walking
  • Crawl or walk later than children of similar age

Note that there are related eye problem symptoms that may occur in children with neonatal ptosis. These include;

  • Eyes that do not line up
  • Double, blurred or distorted vision
  • Eye strain, dizziness or headaches
  • Nearsightedness, farsightedness or astigmatism

No matter the situation, it is crucial you detect your child’s ptosis early and consult with an experienced ptosis surgeon in Singapore to discuss how the condition can be corrected with the treatments available and prevent developmental issues.

What Problems can occur when the ptosis is not detected and Treated on Time?

Untreated ptosis can lead to some conditions in the child’s life. The child is likely to experience visual development issues while growing up and eventually suffer from visual impairments with severity depending on the level of ptosis.

The types of visual development issues that may occur as a result of ptosis include;

Amblyopia (Lazy Eye)

This is also called lazy eye and results from astigmatism or other refractive errors in the eye. In some rare cases, the ptosis might cover the eyelid completely and prevents light from entering the eye and creating an image on the retina.


If there is excessive pressure on the front of the eye that causes distortion and refractive error, it is astigmatism. You may need close observation, treatment with glasses or even surgery to correct the situation.

A Chin up Position

In severe cases, the child might be forced to adopt a chin-up position to be able to counter the droopy eye effect and use the eyes together. This often leads to further neck problems and/or delay of developmental skills.

All these conditions can lead to further problems when ptosis is not detected and treated on time.

How is Ptosis Diagnosed in Children?

Parents and guardians can play a huge role when it comes to the diagnosis of ptosis in children. Although doctors may notice the condition at the baby’s birth, parents are expected to take their child to see a doctor when they notice the signs and symptoms of droopy eyelids.

In the case a parent takes the child to the doctor, the doctor typically will ask about the child’s medical history and conduct some examinations. The doctor might recommend further testing to be sure of the condition.

The further testing may involve;

  • Seeing an ophthalmologist (eye specialist) who will check the child’s vision, take necessary eye measurements and look for the presence of any swelling that might be pushing the eyelid down.
  • Seeing a neurologist (brain and nerve specialist) who will test the blood, nerves and muscles for any issues.

After these investigations, it can be determined if your child’s ptosis is linked to any other health conditions.

how is congenital ptosis treatedHow is Congenital Ptosis Treated for Children and When?

Ptosis treatment differs depending on the severity of the condition.

Mild cases of ptosis are treated using non-surgical solutions like the use of eye patches or special glasses. While the eye patch is worn to strengthen vision in the weaker eye, the special glasses are worn to correct an uneven curve of the cornea that causes blurred vision.

In severe cases, ptosis correction will require surgical means aimed at improving the look and function of the eye. The surgical correction can be an incisional ptosis correction which involves making an incision on the eyelids to fix the drooping eyelid muscle. Another option of ptosis correction surgery in children is Ptosis correction by Frontalis Sling. This involves a surgeon attaching the upper eyelid to the frontalis muscle just below the eyebrows. This is done with the use of a small silicone sling that is passed through the eyelid, underneath the skin.

Note that ptosis correction surgery is not usually performed on patients below the age of five. This is because infants and young children may find it difficult adhering to the pre-operative assessment process or coping with the trauma of post-operative recovery. Furthermore, children’s anatomical structures to be treated are still in the formative stage when they are below five years.

Ptosis treatment surgery in infants can only occur when there is a high risk of amblyopia. This is the reason children with neonatal ptosis should be monitored closely to know if the case is mild or severe.

Will a Child Grow out of the Ptosis Condition?

The truth is that mild ptosis is less noticeable when the child is awake and full of energy. It is more apparent when the child is tired or after consultation with an experienced surgeon. The good news is that not all cases of ptosis in children require surgery.

It is recommended that you discuss all options with your child’s specialist or plastic surgeon.

How Can Parents Help

Parents and Guardians play a considerable role in the detection and treatment of ptosis in their children. Regular checkups can help in detecting the condition.

When you find out your child has ptosis, you can help by;

  • Attending all follow-up doctor visits to keep track of the condition.
  • Give the medicine as prescribed and communicate with your health provider if you have troubles giving the medicine on schedule.
  • Observe your child for head tilting. Communicate to your doctor if your child tilts his or her head. This may be a sign that the eyelid is drooping.

It is vital that you look out for the signs and symptoms of ptosis and droopy eyes, always.

Who to look for if your child shows Symptoms of Ptosis

Do not panic when you notice your child shows the symptoms of ptosis. Simply contact an experienced plastic surgeon in Singapore who deals with pediatric conditions. The doctor will perform surgical treatments to correct the ptosis.

Note that it is essential that you get a referral from the child’s pediatrician or ophthalmologist.

Address Neonatal Ptosis early

In conclusion, Neonatal ptosis can be corrected using neonatal ptosis correction surgery. As a parent, it is crucial you monitor your child and contact experienced specialists when you notice any signs and symptoms. At Dream Clinic, we provide neonatal ptosis treatment surgery and are open to share more advice on the procedure approaches and techniques.

About Dream Aesthetics and Plastic Surgery

Bespoke surgical for cosmetic or medical reasons is what Dream covers to bring out the beauty in every individual. Going beyond the aesthetics and working on physical anomalies are what we value the most in leading our patients to cherish self-improvement and confident lifestyles.

Derived from Associate Professor Vincent Yeow’s long-standing experience performing plastic surgery in Singapore, our treatment plans deliver physical remodelling in our patients’ favour. One of the notable remodellings is droopy eyelid correction. The ptosis surgery used for treatment eventually fixes drooping eyelids, improves vision and enhances appearance.

Most importantly, as a trustworthy plastic surgery and aesthetic clinic, we treasure positive and natural outcomes for each individual. We will ensure to deliver the beauty refinement of your dream without compromising your safety and privacy.