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The effects of unilateral congenital ptosis in a pediatric population


Clinicians discover the ptotic facial side of the face was the nondominant side of the face in a recent study.

The effects of unilateral congenital ptosis in a pediatric population

Investigators from the Department of Ophthalmology, University of Texas Southwestern Medical Center, and the University of Texas Southwestern School of Medicine, Dallas, led by Phillip A. Tensel, MD, reported that in children with unilateral congenital ptosis, the ptotic facial side of the face was the nondominant side of the face. In addition, these patients also had ipsilateral head tilt.1

The clinicians conducted a retrospective review of pediatric patients with unilateral congenital ptosis who were undergoing ptosis repair in order to analyze their facial asymmetry. All patients were treated between January 1, 2017, and December 31, 2020. The investigators collected the following data from the medical charts: sex, age, laterality, margin to reflex distance 1, levator function, and surgical intervention.

The investigators described that they used clear preoperative photos in which the patients’ heads were not turned. The landmarks of the periorbital region, midface, and lower face were marked, and measurements between the landmarks were taken. The measurements between the ptotic and non-ptotic sides were compared.

Results of analysis

A total of 44 patients were included in the study. Nine of the 44 underwent a Mullerectomy, 15 a levator resection, and 20 a frontalis suspension.

The measurements showed the following significant findings: the side of the face with blepharoptosis often had a smaller margin to reflex distance 1 (p < 0.001), a smaller margin to reflex distance 2 (p < 0.005),a smaller horizontal palpebral fissure (p < 0.05), a shorter midface heightp < 0.001), and a more inferiorly displaced lateral canthus (canthal angle, p < 0.001) compared with the side of the face without ptosis. The mean head tilt in the presence of ptosis on the right side (1.37° right tilt) differed significantly from when ptosis was on the left side (0.85° left tilt; p = 0.04), they reported.

The study concluded that in children with unilateral congenital ptosis, the side of the face with the ptosis was the nondominant side of the face. Patients also had ipsilateral head tilt.

  1. Tenzel PA, Brown K, Zhou B, et al. Facial asymmetry in children with unilateral congenital ptosis. Ophthal Plast Reconstr Surg. 2022; published online March 30, 2022; doi: 10.1097/IOP.0000000000002174
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