Question

A 10-year-old female presents with bilateral severe congenital ptosis. Describe the signs and symptoms which indicate poor prognosis.

Hint:

Severe ptosis with absent levator function, amblyopia, and associated abnormalities suggest a poor prognosis for surgical correction.

Answer 1

Step 1: Signs and Symptoms Indicating Poor Prognosis in Congenital Ptosis.
(1) Severe Drooping (Ptosis) with Limited Levator Function:
- If the levator muscle function is less than 4mm, it suggests that the ptosis is likely due to a poorly developed or absent levator muscle, which can lead to poor correction with surgery.
(2) Vision Impairment Due to Amblyopia:
- If the ptosis is severe enough to cause constant obstruction of the visual axis, it may result in amblyopia (lazy eye) in the affected eye, especially in younger children. This is a poor prognostic factor since amblyopia may not be fully reversible.
(3) Poor Bell’s Phenomenon:
- A poor Bell’s phenomenon, where the eye does not move upwards when the eyelid is elevated, may indicate dysfunction of the levator palpebrae superioris muscle or neural abnormalities, leading to a less favorable surgical outcome.
(4) Associated Facial Abnormalities or Other Neurological Symptoms:
- The presence of muscle weakness, craniofacial deformities, or neurodevelopmental abnormalities suggests a syndromic association, which may complicate the management and prognosis of ptosis.