Evaluation of All Causes of Visual Function Loss in Children With Congenital Blepharoptosis

Abstract

Purpose: To evaluate the overall frequency of visual function loss in pediatric patients with congenital blepharoptosis. Methods: This retrospective study was conducted in a tertiary center. The clinical records of patients younger than 18 years who were diagnosed as having congenital blephroptosis, underwent surgery, and had at least 1 year of postoperative follow-up were evaluated. Visual acuity results, presence of structural eye abnormalities, presence and type of amblyopia and strabismus, and refractive errors were recorded. The Mann–Whitney U test, chi-square test, and stepwise regression analysis were used for statistical analyses. Results: The mean final visual acuity was 0.11 ± 0.23 logarithm of the minimum angle of resolution (logMAR) (range: 0.0 to 1.0 logMAR) at the final follow-up visit for 143 eyes of 123 patients (65 male and 58 female). In this cohort, 30 patients (24.4%) had amblyopia and 5 patients (4.1%) had visual loss related to structural eye pathology, amounting to a total of 35 patients (28.5%) with visual function loss. The mean final visual acuities of patients without amblyopia, patients with amblyopia, and patients with organic eye disorders were 0.01 ± 0.03, 0.29 ± 0.28, and 0.55 ± 0.42 logMAR, respectively. Severe blepharoptosis (≥ 4 mm) was present in 25 patients (83.3%) with amblyopia. Deprivational amblyopia was detected in 25 of 36 eyes (69.4%) with amblyopia. Independent risk factors associated with final visual acuity were presence of amblyopia at presentation (correlation coefficient [ß] ± standard error [SE] = −0.29 ± 0.04; P < .001), anisometropia (ß ± SE = −0.27 ± 0.06; P < .001), and ptosis severity (ß ± SE = −0.09 ± 0.04; P = .012). Visual impairment (visual acuity < 20/40) persisted in 11.9% of eyes at the final follow-up. Conclusions: Visual function loss was present in one-third of pediatric patients with congenital blepharoptosis. Both amblyopia and structural eye disorders contribute to visual impairment in this patient population. Structural eye pathology contributes independently to 4.1% of visual loss in this clinical setting. [ J Pediatr Ophthalmol Strabismus . 2020;57(2):97–102.]

Refractive error characteristics and influence on ocular parameters in patients with unilateral congenital ptosis

“…In the present study, the incidence of amblyopia in patients with congenital ptosis was 23%, similar to previous reports [ 21 – 23 ]. In addition, all amblyopic eyes in this study were ptotic, revealing that in patients with unilateral congenital ptosis, amblyopia was found more often in ptotic eyes.…”

“…It has been established that congenital ptosis may increase the incidence of refractive errors, including myopia, hyperopia, and astigmatism, as well as the incidence of amblyopia and anisometropia [ 1 , 19 , 20 ]. In addition, due to amblyopia or deprivation caused by a drooping eyelid covering the pupil, congenital ptosis may have a negative influence on visual acuity [ 21 ]. Our study revealed that patients with congenital ptosis are more likely to experience visual impairment.…”

Refractive Error Characteristics and Influence on Ocular Parameters in Patients with Unilateral Congenital Ptosis

“…In the present study, the incidence of amblyopia in patients with congenital ptosis is 20%, similar to previous reports. [21,22,23] Besides, all cases of amblyopia in this study were ptotic eyes, revealing that in cases with unilateral congenital ptosis, amblyopia was found more often in ptotic eyes. When it comes to the causes of amblyopia in patients with congenital ptosis, astigmatism made up to the largest proportion.…”

“…[1,19,20] Besides, due to amblyopia or deprivation caused by drooping eyelid covering the pupil, congenital ptosis may have a bad in uence on visual acuity. [21] Our study revealed that patients with congenital ptosis are more likely to suffer from visual impairment. Among the 25 patients with unilateral ptosis, the BCVA in ptotic eyes is lower than that in fellow normal eyes, which indicated that congenital ptosis may lead to visual defects.…”