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Some children are born with, or develop, conditions affecting the eyelids and the area around the eye that require specialist oculoplastic surgical assessment. Ptosis (a drooping upper eyelid), dermoid cysts (benign lumps near the eye), epiblepharon (an inturning of the lower eyelid) and periorbital haemangioma (a benign vascular birthmark near the eye) are among the most common oculoplastic conditions seen in children. Left untreated, these conditions can affect visual development and, in some cases, lead to amblyopia (lazy eye). You do not need a GP referral to book a consultation.
If you notice any of the following, a specialist oculoplastic assessment is recommended.
A ptotic or drooping eyelid, especially if it covers any part of the pupil.
A lump near the eye or brow that is growing in size.
A red or purple raised mark near the eyelid that is enlarging.
Persistent eye watering, redness or blinking.
Your child tilting their head or lifting their chin to see.
Complaints of a gritty or scratchy feeling in the eye.
You can book a private oculoplastic consultation for your child at Clinica London directly, without a GP referral. If your child is covered by private medical insurance, your insurer may require a GP referral letter before they will authorise treatment, so we recommend checking your policy before booking. Our team is happy to help with any queries.
Book a children's oculoplastic consultation →This page covers four distinct but related oculoplastic conditions in children. Each has its own causes, presentation and treatment approach, but all are best assessed and managed by a specialist with experience in children's eye care.
A drooping of one or both upper eyelids, caused by a levator muscle (the muscle responsible for lifting the eyelid) that is not functioning normally. It can be present from birth (congenital ptosis) or develop in early childhood. Where the drooping lid obstructs the visual axis, there is a significant risk of amblyopia developing, making early assessment and treatment essential. Other signs include a compensatory head tilt or chin up posture, and a raised brow as the child tries to lift the lid using their forehead muscles.
A benign cyst containing skin cells, hair follicles and other tissue, most commonly appearing as a smooth, firm lump near the outer corner of the upper eyelid or at the brow, often noticed in early infancy. Dermoid cysts are present from birth and grow slowly over time. They should be monitored and, in most cases, surgically removed before school age, since a ruptured cyst causes an inflammatory reaction that makes later surgery much more difficult.
A common condition in young children, particularly those of East Asian heritage, in which a fold of skin and muscle along the lower eyelid causes the lower eyelashes to turn inward and rub against the surface of the eye. Unlike adult entropion, the eyelid margin itself remains in the correct position. Many mild cases resolve spontaneously as the child's face grows, typically by age 4 to 5, but persistent or corneal-damaging cases are treated surgically.
A common, benign vascular birthmark of infancy. It is not usually present at birth but appears in the first few weeks of life, grows rapidly over the first 6 to 12 months, then slowly shrinks over the following months and years. A haemangioma on or around the eyelid needs specialist assessment because of its potential effect on vision during this early period of rapid growth, whether by mechanically obstructing the visual axis or by inducing astigmatism through pressure on the eye.
A consultation for a children's oculoplastic condition at Clinica London is a thorough, unhurried appointment. The surgeon will take time to examine your child carefully, explain what she has found, and discuss the options, including whether or not surgery is needed, and if so, when and what it would involve. If the vision is affected, an orthoptic assessment is also carried out by one of our orthoptists.
Miss Olver will take a careful history, including when you first noticed the condition, whether it has changed over time, any family history, and any concerns about your child's vision or behaviour. For ptosis, she will also observe for any head tilt or compensatory posture, whether the eyelid droop is constant or variable, and whether there is a family history of ptosis.
The eyelids, periocular area and eye surface are examined carefully. For ptosis, measurements are taken of the lid position and levator muscle function, along with photographic documentation. The size, location and consistency of a dermoid cyst are assessed, and for epiblepharon or haemangioma, the degree of lash rubbing, corneal irritation or lesion growth is checked.
For ptosis in particular, a vision assessment is an essential part of the consultation, usually involving age-appropriate visual acuity testing by our orthoptists. Ptosis is frequently associated with squint, so we often request orthoptic input to assess eye movements too. A cycloplegic refraction, using dilating drops that take around 20 to 30 minutes to take effect and leave vision blurred and light-sensitive for several hours, up to 24 hours in some children, may also be carried out to check whether glasses are needed, since ptosis can itself cause astigmatism.
For dermoid cysts that appear to extend deeper than the surface, or for other orbital lesions, imaging (ultrasound, CT or MRI) may be arranged before surgery to confirm the extent of the lesion and plan the surgical approach. Your surgeon will explain if this is needed.
Miss Olver will explain her findings and discuss the recommended management clearly, including whether surgery is needed, whether observation is appropriate, and what the expected outcomes are. There is no obligation to make any decision at the first appointment.
If oculoplastic eyelid surgery is recommended, the procedure is planned with the specialist paediatric anaesthetist at the Portland Hospital. Follow-up appointments monitor healing, check that the surgical aim has been achieved, and, where needed, ensure that orthoptic treatment for amblyopia is progressing as expected.
Children's oculoplastic conditions at Clinica London are managed by our specialist oculoplastic surgeon, Miss Jane Olver, who works closely with our orthoptists. Procedures requiring general anaesthetic are planned in coordination with the specialist paediatric anaesthetist at the Portland Hospital.
As well as being Clinica London's founder and Medical Director, Miss Olver is the practice's specialist oculoplastic surgeon. She has over 30 years of experience in children's eyelid conditions, including ptosis repair, dermoid cyst excision and periocular lesions, and sees children of all ages.
Early assessment gives the best chance of preventing lasting effects on vision. No GP referral needed.
Book a children's oculoplastic consultationAll fees are for private consultations and procedures at 140 Harley Street and our associated surgical facilities. Surgical fees are provided as a full written estimate following your consultation, and include surgeon, anaesthetist and facility fees where applicable.
| Appointment / Procedure | Fee |
|---|---|
| New patient consultation, paediatric oculoplastic assessment (not including diagnostic tests or Orthoptist) | £335–£450 |
| Follow-up consultation | £275–£335 |
| Orthoptist appointment (if required) | £150 |
| Ptosis repair (levator resection), surgical estimate on consultation | Fee on consultation |
| Ptosis repair (frontalis sling), surgical estimate on consultation | Fee on consultation |
| Dermoid cyst excision, surgical estimate on consultation | Fee on consultation |
| Epiblepharon correction, surgical estimate on consultation | Fee on consultation |
| Pre-operative imaging (if required) | Not included |
Assessment and monitoring of periorbital and eyelid haemangioma is included within the standard consultation fees above. Where medical treatment is recommended, this is prescribed separately and its cost will be discussed with you.
Each of these conditions has a different reason why prompt specialist assessment is important. In all cases, waiting and hoping the problem resolves on its own, without a specialist opinion, carries risks that are worth understanding.
The visual system develops rapidly in the first years of life. If a drooping eyelid partially or completely obscures the visual axis, the affected eye is deprived of the clear visual input it needs to develop normally, and amblyopia can result. Ptosis can also induce astigmatism, a second route to amblyopia that is independent of visual axis obstruction. Once the window of visual development has closed (roughly the first 8 to 10 years), amblyopia becomes very difficult to treat. Early surgery, combined with orthoptic management if needed, gives the best chance of normal visual development.
Dermoid cysts should ideally be removed before they rupture. A ruptured cyst causes an acute inflammatory response in the surrounding tissue, making it much harder to remove cleanly and increasing the risk of scarring and a poor cosmetic result. Elective removal before school age, when the cyst is intact and well defined, gives the best surgical outcome.
In most young children with epiblepharon, the eyelashes, while turned inward, are soft and cause only mild irritation. However, persistent rubbing against the cornea can over time cause punctate corneal epithelial erosions and, in severe cases, corneal scarring that may affect vision. Children with epiblepharon should be assessed to establish whether the condition is likely to self-resolve, requires monitoring, or needs surgical correction.
A haemangioma near the eye carries two distinct amblyopia risks: direct obstruction of the visual axis if the lesion is large enough to droop over the pupil, and induced astigmatism from pressure on the cornea. Because the lesion grows fastest in the first 6 to 12 months of life, this is also the period of greatest risk to visual development. Regular monitoring, including refraction, during the growth phase is essential, and any change in the lesion or in vision should prompt a specialist review.
Treatment for each condition is tailored to the child's age, the severity of the condition and, where relevant, whether there is any associated amblyopia. All surgical procedures in young children are performed under general anaesthetic at the Portland Hospital, carried out by a specialist paediatric anaesthetist.
The surgical approach depends on how much levator muscle function is present. When there is reasonable function, levator resection shortens the levator muscle to increase its lifting power. When function is very poor, a frontalis sling procedure connects the eyelid to the frontalis (forehead) muscle, allowing the child to lift their lid by raising their brow. Both are performed under general anaesthetic, aiming to restore a lid position that allows clear vision while achieving the best possible cosmetic appearance.
Dermoid cysts are removed by surgical excision under general anaesthetic, with the aim of removing the cyst intact, including the entire cyst wall and contents. Incomplete removal or rupture during surgery leads to a higher risk of recurrence and a more difficult inflammatory response, so the procedure requires care and experience. For deeper cysts extending into or through the orbital rim, imaging may be arranged before surgery to plan the approach.
Not all cases require surgery. Many children below the age of 4 to 5 can be managed with observation and lubricating eye drops, with regular review to monitor for corneal changes. When epiblepharon causes significant corneal irritation, has not resolved by school age, or is causing corneal damage, surgical correction is recommended: a small ellipse of skin and muscle is removed below the lower eyelid to evert the lash margin away from the eye.
When ptosis has caused or contributed to amblyopia, surgical correction of the eyelid is only part of the treatment. After the lid has been lifted to allow a clear visual axis, orthoptic treatment, typically patching of the stronger eye, is needed to encourage the brain to use the previously deprived eye. Our oculoplastic surgeon, ophthalmologists and orthoptists plan surgery and amblyopia management together, taking into account the child's age, amblyopia risk and severity of the ptosis.
For haemangiomas that threaten vision or are cosmetically significant, topical beta blocker gel is usually the first line treatment and can produce a marked reduction in size, started and monitored under specialist supervision, with screening beforehand to exclude contraindications. Topical timolol is used for smaller, more superficial lesions, and oral propranolol is recommended for larger lesions. Laser treatment and surgery are rarely required and are generally reserved for lesions that do not respond adequately to medical treatment. Regular ophthalmic monitoring, including vision and refraction checks, continues throughout treatment given the amblyopia risk described above.
No GP referral needed. Speak to our team at 140 Harley Street.
Book a children's oculoplastic consultation
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