Congenital Ptosis

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.


One of the most frequently encountered paediatric conditions we treat is ptosis, a condition characterised by the drooping of the upper eyelid, resulting in a smaller eye appearance on one or both sides.

In most cases where children present with a drooping eyelid, congenital ptosis is the likely cause. This is a relatively uncommon condition, which occurs in 1 or 2 per thousand births, often runs in families.

In contrast to adult-onset ptosis, paediatric ptosis necessitates swift specialist assessment and often requires prompt correction to prevent irreversible vision impairment.

This is because, up to the age of 6 or 7 years, the region of a child’s brain responsible for processing visual information requires a consistent input of vision to develop and remain active.

Frequently Asked Questions

When a droopy eyelid hinders this visual input, the central nervous system tends to favour the uncovered eye, leading to subsequent weakening of the connections to that eye. This can result in a condition known as lazy eye or amblyopia. In instances where this process is happening or at risk of occurring, timely eyelid surgery can intervene to prevent or reverse the process, ensuring optimal vision development in a child.

It is important to note that not all cases of childhood ptosis pose a risk of triggering this result. However, a thorough assessment and monitoring by an oculoplastic surgeon in collaboration with a paediatric ophthalmologist are crucial to identify at-risk cases and, when necessary, provide appropriate management.

Ptosis repair in children presents unique challenges but often yields significant benefits. Surgical correction may be offered based on the severity of the drooping eyelid, its impact on the child’s vision, head posture, and psychosocial wellbeing.

Dr Koutroumanos specialises in the management of congenital ptosis repair and regularly receives referrals from various countries at tertiary levels of care.

Several surgical techniques, all performed under general anaesthesia, are available. The choice of technique depends on the child’s age, the severity of ptosis, and the strength of the eyelid muscle. Ensuring the safety of the eyes and achieving a lasting, natural, and functional outcome are primary considerations in any treatment administered.

Ophthalmic & Oculoplastic surgeon
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.