Question

A 10-year-old female presents with bilateral severe congenital ptosis. How would you manage this child?

Hint:

Early surgical intervention, followed by amblyopia treatment and regular monitoring, is essential for optimizing outcomes in congenital ptosis.

Answer 1

Step 1: Management of Bilateral Severe Congenital Ptosis.
The management of congenital ptosis depends on the severity, the presence of amblyopia, and the underlying cause. In this case, the following steps should be taken:
(1) Surgical Intervention:
- Levator Muscle Resection or Frontalis Sling Surgery: In cases with poor levator function (<4mm), frontalis sling surgery may be performed, where the frontalis muscle is used to assist in eyelid elevation.
- For children with better levator function (>4mm), levator muscle resection is performed to tighten the levator muscle and improve eyelid elevation.
(2) Amblyopia Management:
- Patching of the stronger eye may be necessary to treat amblyopia, especially if the ptosis has caused visual axis obstruction in the affected eye. This treatment should be started early to maximize vision recovery.
(3) Vision Rehabilitation:
- Regular follow-up for visual acuity testing is essential to assess the outcome of surgery and monitor for any development of amblyopia in the affected eye.
(4) Management of Associated Conditions (if any):
- If the ptosis is part of a syndromic condition (e.g., BPES or myasthenia gravis), management should be multidisciplinary, involving genetic counseling and treatment for other systemic symptoms.