A 4-Month-Old With a Droopy Eyelid: Ptosis or Something Else?
Carousel1 min read·Published Oct 2026

A 4-Month-Old With a Droopy Eyelid: Ptosis or Something Else?

Illustration showing asymmetric eyelids in a pediatric patient with suspected ptosis.
Slide explaining coronal synostosis with comparison images showing abnormal wide-open eye versus normal droopy eye.
Educational slide explaining how to distinguish lid problems from skull problems by comparing brows and orbital rims.
Quote slide explaining ptosis misdiagnosis in craniofacial cases with physician headshot and credentials.
Comparison of ptosis versus unicoronal craniosynostosis showing abnormal wide eye appearance that mimics expression.
Educational slide showing Harlequin mask sign in coronal synostosis with infant illustration and theatrical mask comparison
Slide explaining why early treatment of coronal synostosis matters to prevent facial deformity and strabismus.
Educational slide on distinguishing true craniosynostosis from positional flattening in infants by examining brow symmetry and nasal deviation.
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Carousel · Oct 2026 · 1 min read

In brief

In brief

Educational carousel exploring the differential diagnosis of apparent ptosis in a 4-month-old infant, highlighting craniosynostosis as a key consideration. Reviews clinical assessment and distinguishing features between true eyelid ptosis and craniofacial structural abnormalities that may mimic drooping eyelids.

Written by the GCMD Library team from the carousel.

Slides

8 pages · click to turn to one
Craniofacial — craniosynostosis. A social-media carousel made possible by Cincinnati Children's.
The text on each slide
  1. Craniofacial Fundamentals | Made possible by Cincinnati Children's | A 4-month-old is brought in with a droopy eyelid. Ptosis is the working diagnosis. | WHAT IS MAKING THE EYES LOOK DIFFERENT? | 1/8
  2. Craniofacial | Fundamentals | Made possible by Cincinnati Children's | WHAT WAS FOUND | THE DROOPY EYE WAS THE NORMAL ONE | Coronal synostosis: The coronal suture fused early on one side. The orbit on that side is pulled up and back. The droopy eye is the normal one, and the abnormal eye is the one that looks wide open. | ABNORMAL | NORMAL | 2/8
  3. Craniofacial Fundamentals | Made possible by Cincinnati Children's | COMPARE THE BROWS, NOT THE LIDS | Compare the brows and orbital rims to each other. That comparison is what separates a lid problem from a skull problem. | The asymmetry is coming from the bone around the eye. | The tip of the nose is pointing AWAY from the fused side. | 3/8
  4. Craniofacial | Fundamentals | Made possible by Cincinnati Children's | Most often I see this misdiagnosed as ptosis. The ptotic-looking eye is actually normal or close to normal in most cases. | Jesse Skoch, MD, FAANS, FACS | Faculty Neurosurgeon, Division of Pediatric Neurosurgery, Cincinnati Children's | 4/8
  5. Craniofacial | Fundamentals | Made possible by Cincinnati Children's | WHY IT CAN SLIP PAST YOU | A WIDE EYE DOESN'T ALWAYS RAISE ALARMS | Ptosis is a pattern we are trained to flag. | A wide eye is not. So the finding hides in plain sight, it just looks like an expression. | ABNORMAL | PTOSIS | 5/8 | NORMAL | UNICORONAL CRANIOSYNOSTOSIS
  6. Craniofacial | Fundamentals | Made possible by Cincinnati Children's | THE MNEMONIC | THE HARLEQUIN MASK | The classic sign of Coronal synostosis is the Harlequin mask: a raised brow and orbital elevation on the affected side + frontal bossing on the opposite side. | 6/8
  7. Craniofacial | Fundamentals | Made possible by Cincinnati Children's | WHY IT MATTERS | Left untreated, coronal synostosis pulls the face and jaw along with it and that is harder to correct than the skull. | About half of these children develop strabismus, so ophthalmology referral is part of the workup. | 7/8
  8. Craniofacial | Fundamentals | Made possible by Cincinnati Children's | THE TAKEAWAY | CHECK THE BROWS. CHECK THE NOSE. | When an eyelid looks droopy in an infant, compare the brows to each other and look at the nose; nasal deviation doesn't happen with positional flattening. | Catching this early is what keeps fronto-orbital advancement on the table instead of later facial surgery. | 8/8
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