Ptosis in childhood

Abstract

Blepharoptosis (ptosis) is a common but often overlooked sign that may serve as a sign/manifestation of other conditions, ranging from a mild and purely cosmetic presentation to a severe and occasionally progressive disorder. Ptosis may show an acute onset or may manifest as a chronic disorder. Its presentation may vary: unilateral versus bilateral, progressive versus non-progressive, isolated versus complex which occurs in association with other symptoms, and congenital versus acquired (often concomitant with neuromuscular disorders).Congenital ptosis includes the isolated type—the congenital cranial dysinnervation disorders, which are further, distinguished into different subtypes such as Horner syndrome (HS), and ptosis as a sign/manifestation of various congenital malformation syndromes.In this article, we review the primary causes of ptosis occurring in childhood, and its various clinical presentations, including a short report on selected cases observed in our institution: a classical isolated familial ptosis comprising 14 members over 5 generations, 3 sibling with isolated congenital ptosis who in addition suffered by episodes of febrile seizures, a patient with Duane retraction syndrome who presented congenital skin and hair anomalies, and a girl with HS who showed a history of congenital imperforate hymen. A flowchart outlining the congenital and acquired type of ptosis and the clinical approach to the management and treatment of children with this anomaly is reported.

Atypical Horner’s syndrome: frequency, features and aetiology in a paediatric population

“…Furthermore, we identified two HS cases which presented with ptosis and sequential development of ipsilateral miosis (cases 1 and 4). To the best of our knowledge these are the only cases of their kind reported in the literature and indicate the importance of considering HS as a differential in children with ptosis [9].…”

Pediatric Ptosis: A Review of Less Common Causes

“…Other causes of pseudoptosis include dermatochalasis, eye infections, corneal abrasions, and ocular foreign bodies. 2 Depending on the suspected etiology of ptosis, diagnostic tools can be beneficial. Blood work should be ordered for serum glucose, creatine kinase, antibodies against AChR antibodies, thyroid function test, and inflammatory markers, depending on the suspected cause.…”

“…1 Of these cases, 90% are congenital, the most common type of ptosis in childhood. 2 In one study, the incidence of simple congenital ptosis was 41%, while in the remaining 59%, ptosis was an associated sign of a systemic condition. 3 The average onset of congenital ptosis in children is at age 12.27 in females and 8.57 in males.…”

Using the “Frontalis-Free Orbital Septum-Complex Flap” in the Correction of Unilateral Congenital Ptosis

“…It is the most prevalent congenital anomaly of the eyelid 1 . This malformation not only affects the appearance, but also induces strabismus, eyestrain, astigmatism, amblyopia, and other ophthalmic diseases 2 . Thus, prompt and effective treatments are of great significance.…”

“…Mid-facial fractures, including zygomatic complex and orbital wall fractures, are common injuries that can result in significant functional and esthetic problems if left untreated. 2 Reconstruction of the fractured bones is critical to restoring normal anatomy and function and preventing complications, such as enophthalmos, diplopia, and entrapment of the extraocular muscles. However, such procedures can be complex and carry the risk of potential complications, as highlighted in this case report.…”