Congenital Ptosis.

-Present from birth.

-Caused by dystrophy of levator muscle where fatty tissue infiltration weakens the muscle.

-Simple means: the only ocular problem is the dystrophic levator muscle in an otherwise healthy child.

-Bilateral & asymmetrical.

-Strabismus and amblyopia can occur.

-

ON EXAMINATION:

-Levator function is reduced (the weak muscle will not move well in upgaze).

-Weak/absent skin crease (due to the weak muscle pulling less on the skin).

-Lid lag on downgaze (weak muscle not moving well in downgaze).

-Early surgical intervention indicated for visual axis obstruction.

-Surgical treatment is based on levator function.

-Frontalis sling: when there is poor levator function of <4mm.

-Levator resection: in mild to moderate ptosis with atleast 4mm levator function.

OTHER CAUSES OF CONGENITAL PTOSIS:

-Congenital 3rd nerve palsy, blepharophimosis syndrome, aponeurotic ptosis, marcus-gunn jaw winking, Birth trauma, Duane syndrome, CFEOM, Kearns Sayre syndrome, Myotonic dystrophy, Myasthenia⁣.

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Image from Rajan Eye Care Hospital

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