Congenital Ptosis Little Rock
Congenital ptosis occurs in children when the levator muscle does not develop properly in utero. In more rare cases, congenital ptosis can rarely occur following birth trauma such as that from forceps delivery. Myasthenia gravis is very uncommon in children but can occur in rare instances.
The timing of ptosis surgery is determined by many factors. Ptosis surgery will be recommended urgently if the eyelid is actually blocking the pupil. When the eyelid is blocking the pupil this can cause amblyopia, or poor development of vision, that can be irreversible if not treated. Another reason patients can have amblyopia is due to anisometropia. Anisometropia means that the refraction of one eye is different from the other and the eyes do not see the same. The “weaker” eye will not developed normal vision and vision loss in that eye can be irreversible if not treated. Anisometropia is treated with refraction and glasses. Why is this important to a patient with ptosis? Patients with congenital ptosis have a very high rate of astigmatism in the affected eye. Because one eye may have more astigmatism than the other, anisometropia is very common in patients with ptosis. This means that just because the ptosis is corrected, does not mean that the patient will not develop amblyopia. The patient still needs regular follow-up with their comprehensive or pediatric ophthalmologist even following ptosis surgery.
During the evaluation Dr. Brock and his staff will determine measurements of the eyelid height. Very importantly, they will determine the levator function. The levator function will determine what approach Dr. Brock recommends for repair. Some patients with congenital ptosis will still have some function of the levator muscle. For patients with fair or good function, the levator muscle can be shortened in order to lift the eyelid. Some patients, however, will have 0-3 mm of levator function. This is considered very poor to absent levator function. In these cases the muscle cannot be shortened enough to both lift the eyelid to its desired height and to maintain protective closure of the eye. Therefore, in these cases of poor or absent levator function, it is recommended that the eyelid be coupled to the frontalis muscle above within the forehead. Between the ages of 0 and 4 this is usually performed with a suture. In older patients and adults, fascia lata, a strip of tissue from within the lateral thigh, is used to couple the eyelid to the frontalis muscle. Because this surgery is performed under general anesthesia, where the patient cannot participate to open and close their eyes, occasionally patients may be required to return to the operating room. Adjustment may be necessary to lift the eyelid further, lower the eyelid further, or adjust the contour of the eyelid and the eyelid crease.
Dr. Brock has extensive training and experience in pediatric oculoplastic surgery. He is considered one of the best pediatric oculoplastic surgeons available to perform congenital ptosis repair. For this reason some of the best ophthalmic surgeons, pediatricians and plastic surgeons in the area regularly refer patients with this condition to Dr. Brock.