In
infants and children ophthalmic plastic diseases have
specific specialized evaluation and treatments. Infants present with congenital (from birth)
diseases such as drooped eyelids, tear duct
obstructions and growths on the
eyelids and behind the eye (orbit).
Infants and children are evaluated to determine
the treatment plan which may involve
observation, medical and/or surgical treatment.
Children with drooped eyelids need a complete ophthalmological examination by a pediatric
ophthalmologist to assess potential visual problems
associated with the
ptosis. In most children, surgical
repair of a significant
ptosis is done at four to five
years of age. The presence of a backward head tilt in a
child or potential visual problems associated with
ptosis would require earlier intervention even during
infancy. Surgical repair may involve levator muscle
tightening or shortening or suspension of the upper
eyelid with suture donor material or silicone material. The choice of procedure will depend on function of the levator muscle. In children with poor levator function,
eyelid suspension is the procedure of choice.
Parents may notice tearing or mucous
accumulation at the inner corners of the eye. These are
the most common symptoms associated with tear duct (lacrimal)
problems in children. For the youngest of infants
parents are instructed in the correct method of massage
to the area to expel accumulation and possibly open the
tear ducts. By 12 months of age, if the symptoms
persist, probing and irrigation of the tear duct is done
in the operating room. Silicone tube placement is
required at this age sometimes and is necessary in most
children with these problems at 14 months and older. It is important the children with this problem are
examined at an early age. Treatment of children for tear
duct obstruction at 24 months or older is more
difficult with some decrease in successful
treatment of the problem.
Children who present with growths on the
eyelids or behind the eye are treated depending on the
size of the growth and type of growth. In children,
many red growths (capillary hemangiomas) resolve with
time on their own.
In cases where the growths are
affecting vision, steroid injections may be given in the
operating room to accelerate the process. Some benign
growths need to have further evaluation by CT scan or MRI to check extension of the growth. As with all
surgery in children, the timing of treatment depends on
the persistence and significance of the problem. General anesthesia is required when surgery is
necessary. This issue is discussed with the family with
appropriate sensitivity. At the New York Eye and Ear
Infirmary, pediatric anesthesiologists administer the
anesthesia. We believe that timing of treatment in the
child is based on the persistence and significance of
the problem. Forthright discussion with the child’s
family is encouraged prior to defining the treatment
plan.
Visit our
ophthalmology /
eye plastic surgery offices in
New York,
Rye Brook and Bronx, NY.
