What are congenital disorders around the eyes?
A variety of congenital disorders can include the eyelids, lacrimal system and orbits including:
Patients are often born with congenital disorders such as congenital ptosis, tear duct disorders, dermoid cysts, or develop them within a year of life, and others can be acquired over time or with trauma/injury. Many of these disorders can be isolated and surgically repaired as an outpatient procedure, while others can be a part of a syndrome of disorders. These patients often require the care of several specialists. Surgery is often performed at a Children’s surgery center with doctors experienced in the treatment of pediatric patients. Dr. Amato has extensive experience in the management of pediatric oculoplastic disorders and will discuss your or your child’s particular needs at your initial consultation. Children typically recover quickly after eyelid and tear duct surgery, but may have bruising and swelling for a few weeks.
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What is the most common orbital mass in children?
Capillary hemangioma and dermoids are benign orbital masses that appear most commonly in children. If small, hemangioma can be observed or treated with medication (beta-blockers) if there is problematic growth. Dermoid cysts can be removed usually after a year of life to avoid rupture and recurrence or episodes of inflammation. There are less common benign and malignant tumors seen in children namely rhabdomyosarcoma, neuroblastoma, retinoblastoma, and glioma and immediate evaluation and treatment by a team of specialists are essential.
What are common injuries around the eye seen in children?
Children can suffer from orbital fractures or lacerations affecting the bones, eyelids and tear ducts. An orbital floor fracture is a common injury from a softball injury or blunt trauma to the eye resulting in a broken bone under the eye. Patients often have trouble looking up, or double vision. This type of injury may require surgery to restore eye movement and position. Other lacerations from falls, dog bites, or accidents may require repair by an eyelid or tear duct specialist to ensure the best cosmetic and functional result. Dr. Amato works with doctors at Texas Children’s and Dell Children’s hospital and has experience treating children of all ages.
What is congenital eyelid ptosis?
Children with congenital eyelid ptosis can be so severe that it is blocking visual development and may require more immediate surgery to improve their chances for full visual development. Their eye doctor can follow many children then decide to have ptosis surgery at school age. Patients with congenital ptosis may require adjustment surgery for the eyelids in the future.
What is congenital blocked tear duct?
Children can also be born with a blocked tear duct membrane that causes discharge and tearing. Usually, with massage of the tear duct within the first year of life, many patients will improve, and surgery can be avoided. Others can undergo a probing of the tear drain to open the membrane and improve tearing. For more information, please refer to Post-op instructions for children under Forms and Pediatric Oculoplastic Surgery section of www.ASOPRS.org.
If there is a recurrence of tearing or infections, children may require a small silicone stent to be placed into the tear drainage system that is removed a few weeks to months later. Rarely, a tear duct may get infected, or be improperly developed and further surgery is performed to open the tear duct in a DCR (dacryocystorhinostomy or balloon procedure). A Jones tube is a procedure that can replace a tear duct through a glass tube in cases where the tear duct has not developed or cannot be opened. Accessory tear ducts can also be seen that may cause tearing, which can usually be repaired.
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Pediatric Eye Surgery FAQs
Your child’s eyes are a beautiful window into their personality, emotions, and self-expression. They can communicate all sorts of emotions, including joy, sadness, curiosity, or pain. However, if your child has abnormally droopy upper eyelids – a condition called ptosis – it can obscure their gaze, causing their sight and communication to suffer.
Some cases of ptosis are mild enough that they don’t obstruct vision. However, moderate to severe ptosis can affect your child’s ability to make eye contact, make it hard for them to see, and lead to unwanted complications.
There are several causes of pediatric ptosis.
- Congenital: Most children who develop ptosis have the genetic form of this disorder, meaning it developed at birth or during infancy. Congenital ptosis can result from a problem with the levator muscle, which keeps the eyelid lifted when your child’s eyes are open, or the result of nerve problems in the affected eye.
- Disease-related: If ptosis develops in your child’s toddlerhood and early adolescence, it can be a red flag of a more serious medical condition. Ptosis can signify an autoimmune disorder, muscle disease, nerve problems, or a local eye issue.
If ptosis isn’t affecting your child’s vision, most surgeons prefer to wait until age 3 or 4, when the child has grown a little bigger and their eyelids and face have had a chance to develop properly. However, surgery is necessary in severe cases, such as amblyopia (lazy eye syndrome), to help prevent further damage to the eye muscles.
Serious complications are rare surrounding pediatric ptosis surgery; however, the most common risks are infection, severely dry eyes, asymmetry, vision impairment, bleeding, scarring, and the need for additional procedures.
Surgery performed by an experienced pediatric ophthalmologist like Dr. Amato has the highest chance of excellent functional and cosmetic results. Dr. Amato’s extensive knowledge of the delicate eye area, eye socket anatomy, and dedication to industry-leading patient safety standards keep any risks at a minimum.
Sometimes, ptosis can recur eight to 10 years after pediatric ptosis surgery. Reported recurrence rates range from 12% to 39% depending on the age the child had surgery, the technique used, and any complications during the recovery process. During your consultation with Dr. Amato, she will discuss success rates using different techniques and what to expect as your child continues to develop into adulthood.