Eyelid, Tear Duct and Orbital Surgery for Children

Why it is not only about appearance. When the eyelid sits low enough to cover the pupil, the eye stops receiving a clear image and the brain begins to favour the other eye. This is amblyopia — a lazy eye — and it is a problem of vision rather than of looks. The period during which it can be influenced is limited.

What is done. The levator muscle is shortened or reattached. When the muscle is very weak, the eyelid is connected to the brow so that the forehead lifts it. The technique is chosen by how much the muscle still works, measured at the examination.

When. If the pupil is covered, earlier. If the eyelid is low but the visual axis is clear, the operation can often wait until the child is old enough for accurate measurement. Both paths are discussed with the parents, with the reasoning for each.

Why parents come. One eye waters constantly. There is discharge in the morning. The area beside the nose becomes red, swollen or tender, sometimes again and again.

What it usually is. In infants the tear duct is often blocked at birth and opens on its own during the first months. Massage and drops are the first step. When the blockage stays, tears cannot drain and the stagnant sac becomes infected — dacryocystitis. When the infection keeps returning, the duct itself is the problem, not the infection.

What can be done. Probing and irrigation in younger children. Intubation with a temporary silicone stent when probing is not enough. Dacryocystorhinostomy — creating a new drainage path — in recurrent and complex cases, including after unsuccessful earlier treatment.

Waiting has a cost, and so does operating too early. The decision is made after examination, not from a photograph or a phone call.

Chalazion and stye — a lump in the eyelid that has not settled with warm compresses and drops. Removal is short and is usually done under brief general anaesthesia in a young child.

Epiblepharon and entropion — the lower lashes turn inward and rub the cornea. The child squints, rubs the eye and avoids light. Correction protects the cornea.

Eyelid lesions and birthmarks — assessed first, removed when there is a reason: growth, irritation, interference with the visual axis, or diagnostic doubt.

Eyelid injuries — a torn eyelid, and particularly a torn tear canal, needs repair by someone who will reconstruct the drainage as well as the skin. Repaired within the right window, the result is better than any later revision.

Orbital conditions — swelling around the eye, displacement of the eyeball, congenital malformations. These are examined and, where appropriate, managed together with paediatric colleagues.

Most of these procedures are day surgery. The child comes in the morning, is operated on, recovers for a few hours and goes home the same day with written instructions and a follow-up appointment.

Anaesthesia is provided on site by an anaesthesiology team with paediatric experience. Parents meet the anaesthetist before the operation, hear how the child will be put to sleep and woken, and are with the child in recovery. Fasting times are given in writing in advance, because a child who has eaten cannot be operated on that day.

The consultation lasts up to 45 minutes. The surgeon examines the eyelids, the tear drainage and the eye movements, takes measurements and photographs, and explains what is a medical indication and what is optional. Parents are present throughout. Where the decision depends on how vision is developing, the assessment is completed before the operation is planned, not after.

Consultation: AED 1,100. Follow-up consultation: AED 600. Prices start from these figures. The cost of surgery is confirmed in writing after the examination and depends on the diagnosis, the technique and the type of anaesthesia. Prices current as of September 2026.

Every operation on a child’s eyelid, tear duct or orbit carries risks: bleeding, infection, asymmetry, under- or over-correction, incomplete eyelid closure, scarring, blockage returning after tear-duct surgery, and the possibility that a second procedure is needed. General anaesthesia carries its own risks, which the anaesthetist discusses separately. Individual results vary. Everything is discussed at the consultation and recorded in the informed consent.