Droopy eyelid (ptosis) may appear as an enlarged or heavy upper lid; or, if it is very slight, it may be noticed only because the affected eye appears somewhat smaller than the other eye. Ptosis usually involves only one eyelid, but both may be affected. Your baby may be born with a ptosis, or it may develop later. The ptosis may be partial, causing your baby’s eyes to appear slightly asymmetrical; or it may be total, causing the affected lid to cover the eye completely. If the ptotic eyelid covers the entire pupillary opening of your child’s eye, or if the weight of the lid causes the cornea to assume an irregular shape (astigmatism), it will threaten normal vision development and must be corrected as early as possible. If vision is not threatened, surgical intervention, if necessary, is usually delayed until the child is four or five years of age or older, when the eyelid and surrounding tissue are more fully developed and a better cosmetic result can be obtained.
Most birthmarks and growths involving the eyelids of the newborn or young child are benign; however, because they may increase in size during the first year of life, they sometimes cause parents to become concerned. Most of these birthmarks and growths are not serious and will not affect your child’s vision. Many decrease in size after the first year of life and eventually disappear entirely without treatment. However, any irregularity should be brought to the attention of your child’s pediatrician so that it can be evaluated and monitored.
Some children will develop lumps and bumps on their lids that can impair development of good eyesight. In particular, a blood vessel tumor called a capillary or strawberry hemangioma can start out as a small swelling, and rapidly enlarge. They will enlarge over the first year of life, and then start to spontaneously resolve over the next few years of life. If they become large enough, they can interfere with your baby’s development of good vision in the affected eye and will need to be treated. Because of their potential to cause vision problems, any child who starts to show any lumps or bumps around either eye should be examined by an ophthalmologist.
A child might also be born with a flat, purple colored lesion on their face called a port wine stain, because of its resemblance to a dark red wine. If this birthmark involves the eye, especially the upper lid, the child may be at risk for development of glaucoma (a condition where pressure increases inside the eyeball) or amblyopia (a weak eye muscle). Any child born with this birthmark needs to be examined by an ophthalmologist shortly after birth.
Small dark moles, called nevi, on the eyelids or on the white part of the eye itself rarely cause any problems or need to be removed. Once they have been evaluated by your pediatrician, these marks should cause concern only if they change in size, shape, or color.
Small, firm, flesh-colored bulges on your child’s eyelids or underneath the eyebrows are usually dermoid cysts. These are noncancerous tumors that usually are present from birth. Dermoids will not become cancerous if not removed; however, because they tend to increase in size during puberty, their removal during preschool years is preferred in most cases.
Two other eyelid problems—chalazia and hordeola or sties—are common, but not serious. A chalazion is a cyst resulting from a blockage of an oil gland. A sty, or hordeolum, is a bacterial infection of the cells surrounding the sweat glands or hair follicles on the edge of the lid. Call your pediatrician regarding treatment of these conditions. He probably will tell you to apply warm compresses directly to the eyelid for twenty or thirty minutes three or four times a day until the chalazion or sty clears. The doctor may want to examine your child before prescribing additional treatment, such as an antibiotic ointment or drops.
Once your child has had a sty or chalazion, she may be more likely to get them again. When chalazia occur repeatedly, it’s sometimes necessary to perform lid scrubs to reduce the bacterial colonization of the eyelids and open the oil gland pores.
Impetigo is a very contagious bacterial infection that may occur on the eyelid. Your pediatrician will advise you on how to remove the crust from the lid and then prescribe an eye ointment and oral antibiotics.