What to do about congenital ptosis?

Congenital ptosis is a common clinical disease, which has a great impact on the patient's physical and mental health. Clinically, congenital ptosis is mainly divided into two types: complete and incomplete. If congenital ptosis is not treated in time, it is likely to induce complications, such as amblyopia. Therefore, we should follow the principle of early detection and early treatment. So what should we do about congenital ptosis?

1. The only treatment for congenital ptosis is surgical correction.

The timing of surgery varies depending on the severity of the disease: severe ptosis must be corrected surgically as soon as possible to avoid affecting visual development; if the degree is mild or moderate, the degree of both eyes is similar, the pupils are not covered, and amblyopia is generally not caused, then the surgery can be appropriately delayed, or the patient can wait until adulthood to undergo surgery under local anesthesia. Since the levator palpebrae superioris muscle can partially develop with age after birth and alleviate the symptoms, the surgery should be scheduled after the child is 3 to 5 years old. Some conservative treatments can be taken before the surgery to avoid amblyopia. In addition, if the child's psychological development is taken into consideration, the surgical time can be appropriately advanced for mild to moderate ptosis. Some situations are not suitable for surgery. For example, if the patient has paralysis of the adductor eye muscles and the eyeball cannot turn upward when the child closes his eyes (Bell phenomenon does not exist), exposure keratitis is likely to occur after surgery, and surgery should be performed with particular caution.

2. Surgical Method

Surgical methods are mainly divided into two categories. One is incomplete ptosis, which can be treated with levator palpebrae superioris muscle strengthening surgery, including levator palpebrae superioris muscle shortening, levator palpebrae superioris muscle folding, and levator palpebrae superioris muscle advancement surgery. The other is complete ptosis, in which the levator palpebrae superioris muscle itself has no motor function and can only use the frontalis muscle to complete the eyelid lifting movement. This type of surgery includes substitute suspension surgery, frontalis muscle flap suspension surgery, etc.

3. Disease prognosis

Generally, there will be varying degrees of regression in the long term after surgery. The more severe the ptosis, the more obvious the regression will be, as it will require the use of substitutes for frontalis muscle suspension. Therefore, the surgeon will generally perform appropriate corrective surgery based on the patient's condition to ensure long-term results. However, overcorrection often results in blinking and eye closing disorders in the short term after surgery. In short, when faced with an eye with developmental defects in the eyelid motor muscles, no current surgical method can perfectly solve its own shortcomings. The choice of surgical method and amount of surgery are all about finding a balance between balancing the surgical effect and reducing the risk of complications. Patients should have an objective understanding of this.