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[Congenital ptosis of the upper eyelid: indication for early ophthalmological examination].

OBJECTIVE: Description of the results of clinical investigation and surgical correction in patients with congenital upper eyelid ptosis.

DESIGN: Descriptive.

SETTING: The Eye Hospital, Rotterdam.

METHOD: Evaluation of clinical findings and results of operative treatment in 114 consecutive patients with congenital ptosis.

RESULTS: Amblyopia was present in 20% of the 114 patients, and was caused by stimulus deprivation due to the ptotic eyelid (22%), strabismus (48%), and refraction disorder (30%). Treatment of amblyopia did not induce visual improvement in 7% of the patients (8/114). These patients were all older than 7 years, meaning they were probably too old for treatment. Of the 114 patients, 14% showed strabismus without amblyopia, 8% showed abnormalities of eye movement without squint, and 6% showed torticollis due to the ptosis. At time of referral 28% were younger than 6 years and 35% had already been treated surgically for the ptosis elsewhere. Operative correction of ptosis induced symmetry within 1 mm in 62%, and symmetry within 2 mm in 22%. Reoperation was performed in 16%. Previous operation elsewhere had no influence on the results.

CONCLUSIONS: Patients with congenital ptosis frequently show amblyopia, strabismus, and abnormalities of eye movement. In the patients referred to us, amblyopia had not always been diagnosed and treated in time. Ophthalmological examination in the first year of life is indicated in these patients. If the ptotic eyelid induces deprivation amblyopia or torticollis, direct ptosis correction is indicated. It is advised for psychological reasons to correct elective cases at the age of 4 or 5 years. For this reason, also, patients should be referred sooner.

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