Congenital ptosis with associated ocular and systemic anomalies and its management: A study

INTRODUCTION: Ptosis (Blepharoptosis) denotes drooping of the upper eyelid. True congenital ptosis includes developmental dystrophy of levator muscle of unknown cause. In true congenital ptosis, deficiency of striated fibers in the levator muscle is present from birth and remains throughout life. The levator and frontalis muscle act in coordination, the frontalis muscle overacts to compensate the loss of elevating action of levator muscle. The ptosis is often unilateral but can be bilateral. The choice of management depends primarily on the levator function. There is increase evidence to show that even if a ptosis partially occludes the pupil, there is a risk of amblyopia and surgery forms treatment of choice. Surgery restores stable, normally functioning eyelid and improves superior visual field. AIM OF STUDY: The main aspect of this study is to analyses the Ocular, systemic associations in congenital ptosis and its management. OBSERVATIONS AND RESULTS: 155 Cases reported with congenital ptosis in the age group of, from birth to 50 years were studied. Among these, 14 cases had family history of ptosis (9.0%). Only one had history of forceps application (0.64%). 95% of cases came for cosmetic purpose and 5% came for defective Vision. 90 male patients with 58.1% and 65 female patients with 41.9% were included in this study. Left eye was involved in 64 patients with 41.2%, right eye in 56 patients with 32.9% and both eyes were involved in 40 cases with 29.1%. ANALYSIS: The present analytical study on evaluation and surgical management of all congenital blepharoptosis was conducted at Regional institute of ophthalmology, Government Ophthalmic hospital, Chennai. 155 cases were evaluated and examined in detailed manner, Ocular and systemic anomalies associations were looked for in this study. The analytical data are as follows: CONCLUSION: The incidence of ptosis was found to be more common in the age group of 11 to 20 years. This shows the cosmetic consciousness in this age group. Majority of patients were male. Left eye predominance and familial associations were noted. Among the congenital ptosis, simple congenital ptosis formed major group. Superior rectus weakness, Blepharophimosis syndrome and Marcus gunn Jaw winking phenomenon formed the major ocular anomalies associations. Congenital heart disease formed the major systemic associations. Three different surgical procedures were followed in most of the cases. Among this, frontalis sling surgery forms the major group. As ptosis leads to un- acceptable cosmetic appearance and defective vision, the fight against ptosis by surgical procedures were successful. A surgery restored a stable, normal functioning eyelid and improves superior visual field, thereby forms the main treatment of choice