Children can suffer from all of the oculoplastic (eyelid, orbit, lacrimal) pathologies that happen in adults, along with congenital birth defects.
Congenital nasolacrimal duct obstruction is the most common cause of tearing in babies and young children. In fact, about 5% of all infants are born with blocked tear drainage ducts. Fortunately, far majority of these blockages open spontaneously during the first year of lift with conservative management (massaging the tear system). For the ones that don’t resolve by themselves or result in infection, then lacrimal tear duct (nasolacrimal duct) probing can be done to open the passage. Rarely, more invasive techniques are needed.
Eyelid Abnormalities in Children
Congenital droopy upper eyelid (congenital ptosis) is the most common eyelid abnormality in children due to weakly formed levator muscle. It is typically unilateral. If significant enough, it can obstruct the vision and cause ambylopia (“lazy eye”), requiring surgery. Congenital ptosis surgery usually requires a technique called “frontalis sling” where the upper eyelid is linked to the forehead, in order to use the forehead muscle (frontalis) to lift the upper eyelid.
Other congenital eyelid malformations are rare. They include turning in (entropion) or turning out (ectropion) of the eyelids, misdirected lashes (trichiasis, epiblepharon), defects of the eyelids (colobomas), and eyelid lesions. Most require prompt surgical treatment to avoid damage to the fragile growing eyeball and prevent visual damage.
Besides surgery, Dr Taban uses nonsurgical technique to treat some congenital eyelid conditions. Read Dr. Taban’s article on using injectable fillers to treat eyelid malpositions: Hyaluronic Acid Gel Injection in Pediatric Population
Orbital Disease in Children
The orbit is the bony socket that hold the eyeball and its associated structures. Orbital disorders are not common in children.
Orbital infection (cellulitis) can occur and usually related to sinusitis. They are treated by antibiotics, although rarely need surgery.
Orbital tumors that occur are usually benign. The most common orbital tumor in children is hemangiomas, which are benign vascular growths. They usually regress after a year but they can cause severe problems, including vision loss if not addressed. A combination of surgery, chemotherapy and sometimes radiation is used to treat these life threatening problems. Of interest, systemic propranolol has recently found to be useful in treating pediatric capillary hemangioma. Read Dr. Taban’s article on Orbital Disease: Propranolol for Orbital Hemangioma.
Who Should Treat Pediatric Oculoplastic Disorders?
The orbit is a small, compact and complex structure. The eyelid is also a mobile, complicated structure, made up of many different layers. Oculoplastic surgeons have undertaken the extra training to deal with the nuances of treating orbital and eyelid diseases and injuries. An oculoplastic surgeon, who is a member of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), is someone who is a board certified ophthalmologist who has completed additional 2-year fellowship training in cosmetic and reconstructive plastic surgery of the eyelids, orbits (eye socket), lacrimal system (tearing system) and surrounding structures.
Dr. Taban is double board-certified by American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Academy of Ophthalmology (AAO), and a diplomat of American Board of Cosmetic Surgery (ABCS). Dr. Taban is an oculoplastic surgeon in Beverly Hills and Santa Barbara with expertise in minimal invasive eyelid and orbital surgery.