Treatment of Congenital Ptosis in the Left Eye (OS)
Surgical correction of congenital ptosis in the left eye is recommended, especially in children under 8 years of age, to prevent amblyopia and improve visual function. 1, 2
Understanding Congenital Ptosis
Congenital ptosis is characterized by abnormal lower positioning of the upper eyelid present at birth. It can be:
- Unilateral (as in this case) or bilateral
- Mild (1-2mm), moderate (3-4mm), or severe (>4mm)
- Associated with other ocular or systemic conditions
Assessment Parameters
Critical Evaluations
- Visual function assessment: Check for amblyopia risk, which occurs in approximately 17% of congenital ptosis cases 3
- Degree of ptosis: Measure upper lid margin to central corneal reflex (MRD1) 4
- Levator function: Determines surgical approach (may be difficult to measure in very young children) 4
- Pupillary occlusion: Determine if the ptosis is obstructing the visual axis 2
- Refractive error: Assess for anisometropia, which can develop secondary to ptosis 5
Additional Examinations
- External examination: Assess for other eyelid abnormalities 6
- Ocular motility: Rule out associated strabismus (present in 19% of cases) 3
- Pupillary examination: Rule out Horner syndrome or other neurological causes 6
Treatment Algorithm
Immediate Surgical Intervention Indications
- Severe ptosis with pupillary occlusion: Surgery is urgent to prevent deprivational amblyopia 2
- Abnormal head posture: Child tilting head back to see under ptotic lid 2
- Developing amblyopia: Despite non-surgical management 5
Surgical Technique Selection Based on Levator Function
Good levator function (>5mm):
- Levator resection or advancement
- Transconjunctival levator plication (suitable for young children) 4
Poor levator function (<5mm):
- Frontalis sling/brow suspension procedure 2
Minimal ptosis:
- Müller's muscle conjunctival resection
- Fasanella-Servat procedure 2
Non-Surgical Management
- Amblyopia monitoring and treatment:
- Regular refraction and visual acuity assessment
- Patching therapy if amblyopia develops 6
- Correction of any associated refractive error
Outcomes and Follow-up
Success rate: Transconjunctival levator plication achieves equalization of lid height in approximately 50% of cases, with minor hypocorrection in 33% 4
Complications:
- Under or overcorrection (most common)
- Lid asymmetry
- Exposure keratopathy
- Lagophthalmos 2
Follow-up schedule:
- First week post-surgery
- Monthly for 3 months
- Every 6-12 months thereafter to monitor for amblyopia 6
Important Considerations
- Timing is critical: Early intervention (before age 8) is essential when visual development is at risk 6
- Multiple procedures: Often more than one surgery is required to achieve optimal results 1
- Amblyopia risk: Congenital ptosis can cause amblyopia through multiple mechanisms:
- Direct visual deprivation (3.2% of cases)
- Induced astigmatism (cylindrical refractive error)
- Associated strabismus 5
Conclusion
Congenital ptosis requires careful evaluation and timely management to prevent permanent visual impairment. The decision for surgical correction should be based primarily on the risk of amblyopia, with consideration of the degree of ptosis and levator function. Early surgical intervention is particularly important when the visual axis is occluded or when there is evidence of developing amblyopia.