Congenital ptosis is the most common cause of ptosis in children. It is due to an abnormal development of the levator muscles of the lid. As a result, the upper lid is droopy, covering part if not the whole cornea, and the upper lid fold is absent. Due to the close embryological development of the levator muscle and the superior rectus muscle, it is not surprising to see an associated difficulty in elevating the eyeball in patients with congenital ptosis. There is also lid lag on downgaze. It is commonly unilateral, but bilateral cases can also be seen. There is no well-defined pattern of heredity.
Ptosis in children can produce dense amblyopia, particularly if it is unilateral, wherein one eyelid interferes with the visual axis or induce astigmatism on the affected eye. Even mild ptosis can induce astigmatism and cause secondary amblyopia. It is believed that children with congenital ptosis develop abnormal head posture such as chin elevation to compensate for the droopy eyelid and to obtain binocular fusion.
Children with congenital ptosis need to be seen by a pediatric ophthalmologist for evaluation of their visual potential. These children need to be refracted and given glasses if a significant astigmatism is present. Then, amblyopia treatment should be started as soon as the refractive correction is given. Ptosis surgery, using either fascia lata or silicone tube, is the final step in the management.