Eyelid almost completely covers one eye

Looking at your child’s eyes, do you notice that one of their eyelids is drooping and that it almost completely covers their eye? This is called ptosis. Find out below how to manage this anomaly.

What is ptosis?

Asymmetry of the eyelids is relatively common in the general population, with perfect symmetry rarely present in nature. However, it can happen that this phenomenon is present in an exaggerated way. The patient then has ptosis.

Ptosis is an eye condition that is characterized by a droop of the upper eyelid, which can cause blurred or reduced vision. This lowering is due to a lack of contraction of the lifting muscle of the eyelid. The degree of sagging of the eyelid is variable. It can be subtle or, in the most severe cases, the eyelid can completely cover the pupil (the visual axis).

Although this disease is not painful, it can cause discomfort for the child and impair vision.

How does this visual pathology occur?

Ptosis can be congenital (present at birth) or acquired (occurring later in life).

It can be caused by various phenomena, such as muscle or nerve problems, lesions, diseases or side effects of certain drugs. It is therefore important to see a doctor for follow-up to determine the exact cause of the ptosis.

Can ptosis affect both eyes?

Yes, ptosis can affect both eyes. When the disease affects only one of the two eyes, it is called unilateral ptosis. And if it affects both eyelids, it is then called bilateral ptosis.

In some cases, the ptosis may be symmetrical, that is, both upper eyelids are lowered in the same way.

In other cases, it can be asymmetrical. One of the two eyes is then more affected than the other.

Should I see an ophthalmologist if my child has an eyelid that covers his eye?

The fact that an eyelid partially or completely covers the pupil (the visual axis) can lead to an asymmetry in visual development between the two eyes, with the partially or completely covered eye being at a disadvantage compared to the uncovered eye.

In addition, the eye with ptosis may have a more marked astigmatism, which is why the visual development of both eyes must be systematically monitored in this situation. We therefore advise you to bring your child to an ophthalmologist.

What tests can the ophthalmologist perform to diagnose ptosis?

This ophthalmic disease is generally visible to the naked eye. However, if the abnormality is minor, the doctor may carry out different examinations.

In children, ptosis is usually congenital. But if it appeared suddenly, the ophthalmologist will start by asking questions about the child’s medical history.

Then, he will ask the child to look in different directions to assess the mobility of the eyelids. He can also ask the child to close his eyes and cover one of them to assess his vision, and to see how the eyelid moves when he opens his eyes again.

In addition to these tests, the ophthalmologist may also use an ophthalmoscope to examine the eyes. This examination consists of illuminating the inside of the eye with a special lamp and looking through the tool to see if the eyelid is lowered or not.

Once the diagnosis has been made, the ophthalmologist will be able to prescribe the most suitable medical treatment for your child.

How can ptosis be treated?

Treatment of ptosis depends on the cause of the eyelid droop and its severity. 

If ptosis is mild and does not significantly affect vision, it may be possible to treat it with eye exercises. These aim to strengthen and tighten the muscles of the eyelid. 

If ptosis is more severe or if eye exercises are not enough, it may be necessary to resort to other treatment methods.

Here are some examples of possible treatments for ptosis:

• If ptosis is caused by a muscle or nerve problem, surgery under general anaesthesiamay be recommended to raise the drooping eyelid. There are several surgical techniques for correcting ptosis, depending on the case.
• When side effects of certain drugs are involved, the doctor may recommend a change of drug or reduce the dose to relieve symptoms.
• If ptosis affects vision and the visual field, the ophthalmologist may propose the wearing of contact lenses to correct the vision.

Find out more about children’s ophthalmology

You now know the main reasons that cause drooping eyelid in children. If you want to learn more about children’s eye diseases, visit our dedicated page. Our ophthalmologists explain.