Question

A 10-year-old female presents with bilateral severe congenital ptosis. Draw a flow diagram showing how you would evaluate this child.

Hint:

A thorough evaluation, including levator function testing and assessment for associated neurological or systemic signs, is essential in planning management for congenital ptosis.

Answer 1

Evaluation Flow Diagram for Bilateral Severe Congenital Ptosis

1. History and Symptoms:

• Age of onset of ptosis
• Any associated symptoms (e.g., double vision, muscle weakness)
• Family history of ptosis or other ocular conditions

2. Visual Acuity Test:

• Check for amblyopia or visual axis obstruction

3. Slit-Lamp Examination:

• Assess the eyelid margin and levator muscle function
• Evaluate for any abnormalities like upper lid fold or lids that do not fully elevate with effort

4. Levator Function Test:

• Measure the amount of upward movement of the eyelid when the patient attempts to open their eye.
• Poor levator function (\( \leq 4mm \)) indicates a poor surgical prognosis.

5. Assess for Associated Syndromes:

• Check for facial dysmorphism, neurological signs, or systemic involvement (e.g., muscle weakness, craniofacial abnormalities).

6. Neurological Examination (if necessary):

• Rule out neurological causes such as third nerve palsy or myasthenia gravis.

7. Imaging (if needed):

• MRI or CT to assess for structural causes or neuroanatomical anomalies.