Association of ptosis and ocular development studied

October 25, 2004

New Orleans-The standard treatment for congenital ptosis is observation for the first 3 to 4 years of life. John Linberg, MD, from West Virginia, suggested that this approach threatens vision and ocular development. He delivered the 35th annual Wendell Hughes Lecture at the annual meeting of the American Academy of Ophthalmology.

Dr. Linberg's thesis is based on results of a study that he and his colleagues performed in newborn chicks in which they induced ptosis. After enucleation, they measured the eyes and found that the eyes were longer by 1 mm than the fellow eyes and had superior regional myopia in the area that was occluded during the study.

"The position of the eyelid changes the size, shape, and refractive error in the eye. Ptosis can affect ocular development at least in animals," he asserted. These changes were later confirmed in later studies performed in monkeys and humans.

"Visual deprivation is the primary suspect in the development of these changes," he said.

Important considerations for early intervention in these patients are that infants with ptosis have head tilt, which interferes with normal motor development and walking; there is a negative effect on visual development; and cosmetic appearance.

Dr. Linberg recommended collaboration with pediatric ophthalmologists. For pediatric patients with amblyopia, strabismus, or a refractive error, he advised immediate surgical intervention. For normal infants who have only ptosis, he recommended surgical repair at 6 to 12 months of age.