Interview: K David Epley, MD, Pediatric Ophthalmology, Childrens Eye Care
Session: Case 1: What Did You Do to My Baby? A Ptosis Surgery Saga
What are some of the issues you face when doing pediatric ptosis surgery?
DE: So, one of the issues with this surgery is when you raise the eyelid, it’s a little startling at first because the eyelid is really open that first few days especially. And there’s an incision scar across the entire eyelid and a few up in the eyebrow. And so it’s just a startling appearance at first. So parents are often like, “oh my gosh, what have you done to my baby?”
It all gets better over time. And by a few months out, they’re doing much better, and it looks more normal. But it’s one of the surgeries that we do that doesn’t give you that instant gratification of a finished result right off the bat.
How do you try to talk the parents down or warn them ahead of time?
Yes, so that’s what it’s all about is education ahead of time. I talk to them multiple times before, because often, we’re doing the surgeries later. And we try to delay until kids are older because their eyelid configuration and their age allow for better, longer term correction.
So, I have many conversations with them over those years just reminding them, when we get to this, it’s going to look really horrible at first, and the eyes aren’t going to close at night. And you have to prepare yourself for this. And leading up to that, I just say this over and over so that when they first see it, it’s not a shock to them. And it still is a shock, because it’s their child, and it looks terrible.
But then they realize, oh, yes, he’s been telling me this for a long time. It’s going to get better. It’s going to get better. It just eases them through it.
Do you find that when the child grows up, you have to correct it again because their eyelids change?
Yes, it can. It’s definitely not unusual to need a second surgery to re-raise it again around the teen years. It depends on the age that you have the initial surgery too.
So, there are some infants or toddlers that start to lose vision from the droopiness, which we call amblyopia. Those kids, we need to get the eyelid out of the way when they’re young so that the amblyopia, that loss of vision, doesn’t get worse and worse. And so, if you’re young and have that surgery, it’s likely that you’ll need a second surgery down the road.
If you can wait until you’re a little older — three to five years of age — the chance of needing a second surgery is even less. If you can wait even longer, then same story. It just pushes that out a bit.