[Kok! Health] Our Child's Drooping Eyelid... "Surgery Is Possible Even at a Young Age"

[Photo by Kim Eye Hospital]

Eyelid surgery, commonly known as 'double eyelid surgery,' is well known as a cosmetic procedure aimed at improving appearance and changing facial impressions. However, it is also frequently performed for therapeutic purposes related to eye function. In such cases, there is no strict age limit for surgery, but it is generally performed from the age of 3. Representative cases of eyelid surgery for therapeutic reasons at a young age include entropion surgery, where eyelashes poke the eyeball, and ptosis surgery, which corrects drooping eyelids.

Entropion is a condition where the edge of the eyelid rolls inward toward the eye, causing the eyelashes to poke the cornea. Although it often occurs as an acquired condition, in young children it is usually congenital. From birth to around one year old, eyelashes are very soft, so it is rare for them to cause corneal injury or irritation. As the child grows and the eyelids settle into place, the eyelash poking may improve. However, if symptoms do not improve by ages 3 to 4, when eyelashes become thicker, surgery may be necessary due to accompanying symptoms such as eye pain, foreign body sensation, redness, photophobia, and irritation around the eyes. If the eyelid shape does not change with growth, these symptoms can worsen, so it is advisable to undergo surgery promptly to prevent complications. Repeated corneal damage can lead to keratitis or corneal ulcers and may result in decreased vision.

The surgical method varies depending on the degree to which the eyelashes poke the eyeball, but generally involves making an incision in the skin below the eyelid, removing the tissues that push the eyelashes toward the eye, and then suturing the area. After surgery, the eyelashes that were pushed toward the eyeball naturally turn outward and no longer poke the eye.

Ptosis, the inability to fully open the eyes, is often perceived as a condition that develops with age but can also be congenital. It occurs when the muscle that lifts the upper eyelid is not fully formed or has developmental abnormalities, resulting in incomplete eyelid opening and a narrow eyelid fissure at birth. If severe, the eyelid can obstruct vision, leading to amblyopia due to impaired visual development. Amblyopia is a vision disorder that cannot be corrected with glasses if treatment is delayed.

Unlike entropion, congenital ptosis rarely improves naturally during growth and usually requires surgical correction. Similar to tightening a stretched rubber band by cutting a portion of it, part of the muscle is excised and then sutured. In severe cases, auxiliary materials such as silicone or fascia, which can substitute for the levator muscle, are used to fix the upper eyelid to the forehead muscle for correction.

The timing of treatment varies depending on severity, but if vision deterioration occurs due to ptosis, surgery is performed after age 3. However, if there is no problem with visual development, it may be better to monitor the condition with regular ophthalmologic exams until adolescence before performing surgery. Therefore, it is important to consult a specialist in oculoplastic surgery.

During adolescence, double eyelid surgery is often considered for cosmetic reasons. Undergoing buried suture double eyelid surgery, which simply folds the eyelid, is not problematic even in adolescence. However, excessive removal of eyelid fat can cause the upper eyelid to appear sunken from the early 20s to 30s, making one look older and giving a tired impression. It is advisable not to undergo overly aggressive surgeries that negatively affect the ocular surface, such as excessive orbital fat removal or lateral and medial canthoplasty.

Dr. Kim from the Oculoplastic Surgery Center at Baekgwanghwa Kim Eye Hospital stated, “The condition of the eyes in infancy and early childhood affects lifelong visual development. It is best to visit an ophthalmologist without delay and receive appropriate treatment and surgery through consultation with a specialist.”