Eleven-year-old Andy Ho's mother was anxious about his upcoming admission to secondary school. But Ho (names changed for patient confidentiality reasons) had more reason than usual to worry about her son.
Andy's eyes were not the same as most other children. As an infant, he could not seem to open his eyes properly. It turned out that his eye muscles were too weak to fully open, so at age two, he underwent an operation to strengthen those weak eyelid muscles. But it made only a slight improvement to his right eye, keeping it slightly more open than the left.
The young boy was well aware of the differences in his appearance; he often avoided looking directly at others and was terribly shy. As he grew older, the condition took a toll on his social and emotional development.
While looking different may be difficult for a primary school pupil, secondary school presents its own heady and potentially crushing mixture of escalating peer pressure, increased need for social acceptance and belonging, as well as a growing awareness of the opposite sex. Andy's self-esteem could suffer even deeper trauma.
Ptosis, or drooping eyelid, is caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves that control those muscles, or looseness of the skin of the upper eyelids.
Ho thought that the earlier failed attempt to correct the condition doomed Andy to suffer the rest of his life until her friends persuaded her to seek a second opinion, especially with the important milestone of secondary school looming. SheJ took the boy to see Dr Dorothy Fan Shu-ping and Dr Alvin Kwok Kwan-ho, consultant ophthalmologists with the Hong Kong Sanatorium and Hospital.
Fan explained that ptosis not only presented a cosmetic and emotional concern. In children younger than eight years old, the drooping eyelids could also result in vision problems and scramble the development of vision in their brains. It could cause astigmatism, and even amblyopia (also known as 'lazy eye') where the eyes are unable to see details properly. But treatment was available.