Clinical and demographic characteristics of ptosis in children: a national tertiary hospital study

Abstract

Purpose: To study the demographic and clinical characteristics of children who present to our hospital with blepharoptosis.

Methods: A retrospective review of the hospital records of children presenting with blepharoptosis between November 2002 and December 2010 was conducted. Demographic data (age at presentation, gender, and family history) and clinical data (severity, etiology, and associated conditions) were studied. The number and type of any surgical procedure was also recorded.

Results: A total of 408 eyes of 336 children were reviewed. The mean age at presentation was 3.2 years (range 0.25-10 years). Blepharoptosis was unilateral in 64.7% of cases, 74% of which affected the left eye. A positive family history was elicited in 19.4% of cases. Recurrent ptosis constituted 9.3% of presenting cases. The commonest type was congenital (68.9%) followed by blepharophimosis syndrome (16.7%). Associated considerable refractive errors occurred in 13.2% of cases, strabismus in 6.8% of cases, and amblyopia attributed solely to occlusion in 10% of cases. Frontalis suspension was the most common surgery (58%) followed by anterior approach levator muscle resection (29%) and Whitnall sling procedure (13%). Undercorrection, whether primary or late, occurred in 36.5% of cases. The mean number of operations performed was 1.5 (range 1-4).

Conclusions: Blepharoptosis in children is most commonly dystrophic with poor levator function showing a predilection to left side affection. Associated strabismus, refractive errors, and amblyopia should be considered for proper management of these patients. More than one surgery is required to correct the ptosis even in experienced hands.