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Ophthalmology and Visual Sciences

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Congenital Ptosis

Isolated Congenital Ptosis

EPIDEMIOLOGY
  • Presents at birth
  • Usually non-progressive
  • May have a familial component

SIGNS

  • Unilateral or bilateral ptosis
  • Poor levator function
  • Poor eyelid crease
  • Amblyopia/irregular astigmatism

SYMPTOMS

  • Drooping of one or both eyelids
  • Not associated with other ocular or systemic disorders
  • No variation in eyelid position with jaw movement or ocular motility

TREATMENT

  • Depends on amount of ptosis and levator function
  • Frontalis sling (either unilateral versus bilateral) versus levator resection
  • Observation is appropriate if there is no amblyopia and the patient has not adopted an abnormal head position

References

  1. Allen C and Rubin P. Blepharophimosis-ptosis-epicanthis Inversus Syndrome (BPES): Clnical Manifestation and Treatment. International Ophthalmology Clinics 2008; 48(2): 15-23.
  2. Anderson R, et al. Whitnall's sling for poor function ptosis. Arch Ophthalmol 1990; 108: 1628-1632.
  3. Baldwin H and Manners R. Congenital Blepharoptosis. Ophthalmic Plastic and Reconstructive Surgery 2002; 18(4): 301-307.
  4. Beard C. A new treatment for severe unilateral congenital ptosis and for ptosis with jaw-winking. Am J Ophthalmol 1965; Feb;59:252-8.
  5. Beard, C. "Congenital Ptosis" in Ptosis St. Louis, MO. CV Mosby Company: 1976, 91-115.
  6. Berke, R. Results of resection of the levator muscle through a skin incision in congenital ptosis AMA Arch Ophthalmol. 1959 Feb;61(2):177-201.
  7. Berke, R. The surgical correction of congenital ptosis Trans Pa Acad Ophthalmol Otolaryngol. 1961;14:57-61
  8. Biousse V and Newman N. Third Nerve Palsies. Seminars in Neurology 2000 20(1): 55-74.
  9. Caballero P et al. Chronic Progressive External Ophthalmoplegia: A report of 6 cases and a review of the literature. The Neurologist 2007; 13(1): 33-36.
  10. Demirci H, et al. Marcus Gunn Jaw-Winking Synkinesis. Ophthalmology 2010;117(7):1447-52.
  11. Epstein G and Putterman A. Supermaximum levator resection for severe unilateral congenital ptosis. Ophthalmic Surg 1984; 15(12): 971-9
  12. Heidary G et al. Congenital Fibrosis of the Extraocular Muscles. Seminars in Ophthalmology 2008; 23:3-8.
  13. Jordan D and Anderson R. Obtaining fascia lata. Arch Ophthalmol 1987; 105: 1139-1140.
  14. Katowitz J. Frontalis Suspension in Congenital Ptosis Using a Polyfilamet, cable-type suture. Arch Ophthalmol 1979; 97: 1659-1663.
  15. Kersten R, et al. Unilatereal Frontalis Sling for the Surgical correction of unilateral poor-function ptosis. Ophthalmic Plastic and Reconstructive Surgery 2005; 21(6): 412-417.
  16. Kook K, et al. Scanning electron microscopic studies of supramid extra from the patients displaying recurrent ptosis after frontalis suspension. American Journal of Ophthalmology 2004; 138(5): 756-763.
  17. Lee M, et al. Frontalis Sling Operation using silicone rod compared with preserved fascia lata for cogenital ptosis. Ophthalmology 2009; 116(1) 123-129.
  18. McMullan T et al. Towards an understanding of congenital ptosis. Orbit 2006; 25(3): 179-184.
  19. Mirzai H and Baser E. Congenital Horners' syndrome and the usefulness of the apraclonidine test in its diagnosis. Indian Journal of Ophthalmology 2006; 54: 197-199.
  20. Sieb J et al. Congenital Myasthenic Syndromes. Seminars in Pediatric Neurology 2002; 9(2): 108-119.
last updated: 07-20-2010

Written by
Nandini Gandhi, MD

Reviewed by
Richard C. Allen, MD

Gandhi N, Allen RC.
Congenital Ptosis. EyeRounds.org. July 20, 2010; Available from: www.EyeRounds.org/ cases/114-Congenital-Ptosis.htm

Case Presentation

Clinical Course

Differential Diagnosis and Discussion

Isolated congenital ptosis

Ptosis associated with ocular and systemic abnormalities

Treatment of Ptosis

Summary and References

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