-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.
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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