Strabismus Associated with Congenital Ptosis
Lauren Fletcher, DO; Leemor Rotberg, MD
Children’s Hospital of Michigan
Introduction: Congenital upper eyelid ptosis has previously been recognized to be associated with strabismus and amblyopia; however, the frequency of strabismus among patients with ptosis has varied widely. Griepentrog and Mohney identified strabismus in only 18% of children with ptosis while Anderson and Baumgartner found strabismus in 36% of patients and Thapa reported strabismus in 27% of patients with congenital ptosis. Our purpose was to determine the frequency and type of strabismus in patients with congenital ptosis. We were also interested in the association, if any, of amblyopia or anisometropia to strabismus in patients with congenital ptosis.
Methods: In this retrospective, cohort study, we reviewed the charts of over 430 patients for the prevalence of strabismus, amblyopia and anisometropia in children who were diagnosed with congenital eyelid ptosis from 1997 through 2017.
Results: Strabismus was diagnosed in 103 (23.6%) of the 437 patients with congenital ptosis. Anisometropia occurred in 17.4% of patients with ptosis and strabismus, while amblyopia occurred in 45.6%. Children with bilateral ptosis developed strabismus on average 2 years later than patients with unilateral ptosis (5.4 yrs and 3.4 years, respectively). Of note, 12.6% of the patients with ptosis and strabismus were also developmentally delayed.
Discussion: Strabismus occurred in almost 24% of the children in this study. This is significantly higher than the general population where strabismus occurs in just 2-3% of children. Similarly, while amblyopia is present in 2-3% of the general population, nearly half of children with congenital ptosis in our study experienced amblyopia.
Conclusion: Based on our findings, an ocular motility evaluation and continued follow up of children with congenital ptosis remains an important practice pattern for the ophthalmologist.
References: 1. Anderson RL, Baumgartner SA. Strabismus in Ptosis. Arch Ophthalmol. 1980;98(6):1062-1067. doi:10.1001/archopht.1980.01020031052008
2. Griepentrog GJ, Mohney BG. Strabismus in childhood eyelid ptosis. Am J Ophthalmol. 2014;158(1):208-210.e1. http://search.proquest.com.proxy.lib.wayne.edu/docview/1535066385?accountid=14925. doi: http://dx.doi.org.proxy.lib.wayne.edu/10.1016/j.ajo.2014.04.001.
3. Harrad, R., Graham, C. and Collin, J. (1988). Amblyopia and strabismus in congenital ptosis. Eye, 115(2), pp.625-627