Congenital Eyelid Malpositions

One of the most demanding and technically challenging aspects of oculoplastic surgery is paediatric surgery. The tissues are smaller, they’re much less forgiving, and incisions need to be completely invisible because the skin is very soft and has no lines to hide the incisions in. The need for precision is paramount, because even the smallest error can have lasting consequences on a child’s development.


An intricate network of minuscule muscles, tendons, and tissues is designed to facilitate the seamless movement of the eyelids across the surface of our eyes, a process repeated thousands of times each day.

Acting as a protective wiper, the eyelids must have perfectly smooth and angled edges to safeguard against potential damage to the ocular surface. This delicate balance of eye tissues can sometimes by slightly out of balance.

Some children can be born with a slight inward turning of the eyelid, known as entropion, or, less frequently, an outward-turning eyelid, referred to as ectropion.

Another common occurrence is when the eyelid margin maintains its ideal shape, but a skin fold pushes the eyelashes onto the eye, a condition termed epiblepharon. In certain cases, even with normal tissue anatomy, an extra row of eyelashes may pose challenges to the eye.

Is surgical intervention necessary?

While some cases may see a gradual improvement as the child’s face develops, it is only through a qualified assessment that more severe instances requiring surgical intervention to prevent potential eye damage can be identified and addressed.

Oculoplastic surgeon London


Dr Nick Koutroumanos

Dr Nick Koutroumanos is a London-based Ophthalmic & Oculoplastic surgeon, with particular subspecialty expertise in ophthalmic plastic & reconstructive eyelid, orbital and lacrimal surgery.

His private practice, based at The Hospital of St John & St Elizabeth in St John’s Wood complements his work in charge of a large NHS oculoplastics practice at the Royal Free Hospital in Hampstead.

A qualified senior trainer and Royal College Examiner in ophthalmic plastic surgery, cataract surgery and general ophthalmology, he runs an Oculoplastics Fellowship training programme that is highly sought-after by both UK and international candidates.

Kind Words from Our Patients


A true perfectionist

Words are not enough to express my sincere gratitude for the care and dedication Dr Koutroumanos put into my journey. I felt safe and secure in his hands. This is someone who truly cares about outcome and ethics of practice. A true perfectionist. I would not hesitate to wholeheartedly recommend him.

100% worth it

I had surgery a few days ago with Dr Koutroumanos for congenital ptosis. It’s early days but I don’t think it’s too early to say the results will be life changing for me in terms of confidence levels. I struggled at school due to the condition and have learnt to live with it – that is until I saw the doctor who was reassuring from the start and has just done the best job. 100% worth it and amazing to know I was in such safe hands. I can’t thank him enough.

I’m really happy with my results

I’ve recently had a brow lift and blepharoplasty with Mr N Koutroumanos. The whole process from start to finish was handled professionally and each process was very informative. I’m still at the recovery stage, so far I’m really happy with my results. Highly recommend using Mr N Koutroumanos services.