Children can be born with, or can develop, a number of problems best treated by an oculoplastic specialist. Children can have blockages of the tear drainage ducts, abnormalities of their eyelids and eye socket, tumors, or other birth defects.
Excessive tearing, eyelash crusting, and occasional discharge are all symptoms of a congenital blockage of the tear drainage duct, or nasolacrimal duct. This disorder is relatively common; about 5% of newborns are born with a blockage. Fortunately, the condition will resolve on its own 90% of the time by the child’s first birthday. Massaging the tear drainage system during this time may be helpful; topical antibiotic drops may be used for severe mucus discharge.
Surgery is usually reserved for blockages that persist beyond the first birthday or, in rare instance, for severe infection during the first year of life. The surgery involves probing and opening the tear drainage duct and is highly successful. Occasionally, stents are placed for several months or a balloon catheter is used during surgery to stretch the tear drainage duct further. These additional procedures are more commonly needed and used in children who are not being treated until they are older.
The most common congenital eyelid abnormality requiring intervention is ptosis, or a droopy eyelid. In children, ptosis is caused by abnormal development and weakness of the muscles that raise the eyelid. Congenital ptosis may be unilateral (one sided) or bilateral (both sides). It can be mild and only noticeable when the child looks up or severe and interfering significantly with the child’s ability to use that eye. In moderate and severe cases the droopy eyelid can interfere with proper visual development, leading to permanent amblyopia (“lazy eye”). Surgery is required in order to lift the eyelid; the surgical technique and timing of how quickly to proceed with surgery will be determined by Dr. Dal Canto based on the severity of the ptosis and the degree of eyelid muscle function.
Other abnormalities of the eyelid include misdirected eyelashes, turning in or out of the eyelid, congenital defects of the eyelid, and growths deep within or superficially in the skin of the eyelid. Again, these problems may need to be addressed surgically to restore the eyelids normal function of protecting the eye and allowing for normal visual development.
The orbit, or eye socket, surrounds and protects the eye. The most common problem of the orbit in children is bacterial infection, or orbital cellulitis. This usually results from bacterial infections spreading from the sinuses, though it can occur after trauma as well, and is thankfully relatively rare. Aggressive, prompt treatment with antibiotics and sometimes surgery is needed to treat the infection before it causes permanent vision loss.
Tumors can develop within the orbit or at the junction of the bones around the rim of the orbit. Some tumors, such as dermoid tumors, are benign (not spreading or invasive) but should be removed to protect from rupture and inflammation with trauma. Others, such as hemangiomas, grow over the first 1-2 years of life, but then regress, or shrink away, on their own. These may be simply observed as long as visual function and development are not impaired. Unfortunately, aggressive orbital tumors can develop in children as well, requiring surgery, chemotherapy, and sometimes radiation therapy to treat these life threatening problems.
Finally, trauma to or around the eye can result in fractures of the orbital bones or lacerations to the eyelids and tear drainage ducts. Depending on the extent of the injury, surgery may be required to correct the problem. Surgery may be urgently performed within several hours or delayed several weeks depending on the particular injury.
As a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), Dr. Dal Canto has extensive training in problems that involve the eyelids, tear drainage system, and orbits in children as well as in adults. As a board certified ophthalmologist, he not only is an expert in dealing with the eyelids and orbits but is keenly aware of the need for appropriate visual development, which often is tied to eyelid and orbital function.
Before and After Photographs
(WARNING: Some of the photographs may be graphic in nature.)
Patient #1: Pediatric Dermoid Tumor, Right Orbital Rim
Patient #2: Congenital Ptosis: Left Upper Lid Repair