Dr William Katowitz: Ptosis Surgery Is Usually Elective and There Are Alternatives

Whether or not a child’s vision is impacted by ptosis, there are usually alternatives to surgery, which is elective, said William Katowitz, MD, attending surgeon in the Division of Ophthalmology at Children's Hospital of Philadelphia.

Transcript

How do you know if a more conservative management can be followed instead of surgery in pediatric ptosis?

So, ptosis, which is a Greek word to describe fallen, describes lids that are not the same height, or that are blocking part or all of the vision. And I tell parents, the same 4 things I just said: I want to know what's causing a droop, I want to know how a child sees, I want to know how they look, and how they feel. And I always start with the most important thing, how a child sees.

So, if the vision is not being impacted, then it really allows us to feel more confident that we are dealing with a more elective situation. And even if the vision is impacted, there are alternatives to surgery. So, it's incredibly rare that I'm quite forceful in my recommendation for surgery. When a child comes in looking like this, and they can't open their eyelid at all, I really tell them that they're running the risk of visual deprivation. But when you have a droop, where it's essentially like wearing a baseball cap, then usually the vision isn't severely impacted unless we can document it. And even if it is impacted, there are alternatives.

So, I always, once again, leave it up to the parents and ultimately the patient to want the surgery. And I would say most of what we do is truly elective, although we can't undervalue the import of appearance, and the way it may impact the way a person feels. So, when it comes to ptosis, it's rare that we treat it as an urgency unless it's what we call complete ptosis, where the eye is being occluded in the developing visual pathway in a child, let's say under the age of 1. In most cases, it's truly elective, and it's elective to the point that the child and the parents need to be bought into doing it.