eMedicine Specialties > Ophthalmology > Lid

Ptosis, Congenital: Follow-up

Author: Donny W Suh, MD, FAAP, Clinical Assistant Professor, Pediatric Ophthalmology Service, University of Nebraska Medical Center; Pediatric Ophthalmologist, Adult Strabismus Specialist, Wolfe Eye Clinic, PC; Consulting Staff, Blank Children's Hospital, Mercy Medical Center of Des Moines, Iowa Methodist Hospital of Des Moines, and Marshalltown Medical Center
Contributor Information and Disclosures

Updated: Nov 6, 2007

Follow-up

Further Outpatient Care

  • Patients are initially monitored every 2-4 weeks for signs of exposure keratopathy, infection, granuloma formation, and overcorrection and undercorrection. External photographic documentation can be helpful in monitoring patients.
  • Following the surgery, visual acuity, head posture, and refractive error should be carefully monitored. Any residual amblyopia should be treated aggressively.

Complications

  • Complications associated with the frontalis suspension procedure include the following:
    • Granuloma – If suspension materials are not placed well beneath the skin, granuloma formation may occur. Granulomas should be treated conservatively because they tend to eventually resolve.
    • Lid asymmetry
    • Overcorrection with exposure keratopathy and dry eyes
    • Undercorrection – Suspension materials may dissolve or break. Suture material may tear through soft tissue. Undercorrected congenital ptosis repair may require repeat surgery.
    • Infection

Prognosis

  • The repair of congenital ptosis can produce excellent functional and cosmetic results.
  • With careful observation and treatment, amblyopia can be treated successfully.
  • Of patients who require surgical intervention, 50% or more may require repeat surgery in 8-10 years following the initial surgery.

Patient Education

  • Although not all patients with congenital ptosis need surgical intervention, patients need to be closely monitored for the possible development of deprivational amblyopia. Since amblyopia may not be reversed after age 7-10 years, appropriate and timely medical and surgical treatment of congenital ptosis is critical to preserve the child's vision.
  • Uncorrected congenital ptosis can result in amblyopia secondary to deprivation or uncorrected astigmatism.
  • An abnormal eyelid position can have negative psychosocial effects.
  • Uncorrected acquired blepharoptosis results in decreased field of vision and frontal headaches.

Miscellaneous

Medicolegal Pitfalls

  • Early consultation to avoid amblyopia
  • Must be able to rule out and document other possible causes of ptosis (eg, Horner syndrome, third cranial nerve palsy)
 
Acknowledgments

I would like to thank my family for their patience and unremitting support.



More on Ptosis, Congenital

Overview: Ptosis, Congenital
Differential Diagnoses & Workup: Ptosis, Congenital
Treatment & Medication: Ptosis, Congenital
Follow-up: Ptosis, Congenital
Multimedia: Ptosis, Congenital
References
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References

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  2. Bergin DJ. Management and surgery of congenital and acquired ptosis. Continuing Ophthalmic Video Education. 1990.

  3. Bernardini FP, Devoto MH, Priolo E. Treatment of unilateral congenital ptosis. Ophthalmology. Mar 2007;114(3):622-3. [Medline].

  4. Clark BJ, Kemp EG, Behan WM, Lee WR. Abnormal extracellular material in the levator palpebrae superioris complex in congenital ptosis. Arch Ophthalmol. Nov 1995;113(11):1414-9. [Medline].

  5. Guercio JR, Martyn LJ. Congenital malformations of the eye and orbit. Otolaryngol Clin North Am. Feb 2007;40(1):113-40, vii. [Medline].

  6. Malone TJ, Nerad JA. The surgical treatment of blepharoptosis in oculomotor nerve palsy. Am J Ophthalmol. Jan 15 1988;105(1):57-64. [Medline].

  7. Meyer DR, Rheeman CH. Downgaze eyelid position in patients with blepharoptosis. Ophthalmology. Oct 1995;102(10):1517-23. [Medline].

  8. Wabbels B, Schroeder JA, Voll B, Siegmund H, Lorenz B. Electron microscopic findings in levator muscle biopsies of patients with isolated congenital or acquired ptosis. Graefes Arch Clin Exp Ophthalmol. Oct 2007;245(10):1533-41. [Medline].

  9. Weinberg DA, Lesser RL, Vollmer TL. Ocular myasthenia: a protean disorder. Surv Ophthalmol. Nov-Dec 1994;39(3):169-210. [Medline].

  10. Yilmaz N, Hosal BM, Zilelioglu G. Congenital ptosis and associated congenital malformations. J AAPOS. Jun 2004;8(3):293-5. [Medline].

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Further Reading

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Keywords

congenital ptosis, drooping of the upper eyelid, droopy eyelid, droopy lid, droopy eye, congenital myogenic ptosis, congenital aponeurotic ptosis, congenital neurogenic ptosis, localized myogenic dysgenesis, amblyopia, strabismus, blepharoptosis

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Contributor Information and Disclosures

Author

Donny W Suh, MD, FAAP, Clinical Assistant Professor, Pediatric Ophthalmology Service, University of Nebraska Medical Center; Pediatric Ophthalmologist, Adult Strabismus Specialist, Wolfe Eye Clinic, PC; Consulting Staff, Blank Children's Hospital, Mercy Medical Center of Des Moines, Iowa Methodist Hospital of Des Moines, and Marshalltown Medical Center
Donny W Suh, MD, FAAP is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Medical Association, and Iowa Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American College of Surgeons, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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