Congenital Ptosis

• Present from birth.

• Caused by dystrophy of levator muscle where fatty tissue infiltration weakens the muscle.

• Simple means: the only ocular problem is the dystrophic levator muscle in an otherwise healthy child.

• Bilateral & asymmetrical.

• Strabismus and amblyopia can occur.

ON EXAMINATION:

• Levator function is reduced (the weak muscle will not move well in upgaze).

• Weak/absent skin crease (due to the weak muscle pulling less on the skin).

• Lid lag on downgaze (weak muscle not moving well in downgaze).

• Early surgical intervention indicated for visual axis obstruction.

• Surgical treatment is based on levator function.

• Frontalis sling: when there is poor levator function of <4mm.

• Levator resection: in mild to moderate ptosis with atleast 4mm levator function.

OTHER CAUSES OF CONGENITAL PTOSIS:

• Congenital 3rd nerve palsy

• Blepharophimosis syndrome

• Aponeurotic ptosis

• Marcus-gunn jaw winking

• Birth trauma

• Duane syndrome

• CFEOM

• Kearns Sayre syndrome

• Myotonic dystrophy

• Myasthenia⁣

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Image from Rajan Eye Care Hospital

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