Reasons why your baby's eyes may not open fully and what you can do about it

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Dear Dr Ombeva,

My son’s left eye is always half closed since he was born, and now he is four months old. I thought this would change with time but I think it's getting worse. I have tried several times to open it using my fingers but whenever I do this, he closes both eyes. What could be wrong with him?

Bertha

Dear Bertha,

I think your child has a problem called droopy eyelid (ptosis). Usually, it can appear as an enlarged or heavy upper lid; or sometimes the affected eye appears smaller than the other eye.

It is caused by weakness of the muscles responsible for raising the eyelid, or damage to the nerves which control those muscles, or loose skin of the upper eyelids. In the more serious cases, the lids may droop so much that they block the child’s vision.

This problem often involves only one eyelid. Sometimes a baby is born with a ptosis, or in other cases it may develop later. It may cause the baby’s eye to assume an irregular shape (astigmatism), thus threatening normal vision.

Treatment of ptosis allows for normal vision development. If it is not corrected, a condition called amblyopia (lazy eye) may develop.

If left untreated, amblyopia may lead to permanent poor vision. A child born with ptosis may also have other associated medical problems.

Children with ptosis often tip their heads back into a chin-up position to try and see underneath their eyelids, or sometimes they raise their eyebrows in an attempt to lift up the lids.

For ptosis that does not threaten vision, surgical intervention, is usually delayed until the child is four-five  years age.

Generally, the treatment for childhood ptosis is surgery. Surgical repair is usually very successful in restoring the appearance and function of the eyelid. Rarely, after surgery, the eyelids may not appear perfectly symmetrical nor return to full eyelid movement, thus requiring more than one operation.

Consult an eye doctor (ophthalmologist) who will assess your child and determine if an operation is needed.

— Dr Ombeva Malande is a paediatrics and child health expert