Congenital Ptosis

Congenital ptosis presents within the first year of life, and is either isolated or occurs as a part of an ocular or systemic disorder. Management requires a specific approach to avoid the development of amblyopia and long-term visual compromise. Surgical repair is challenging; the choice of procedure depends on patient-specific factors, such as degree of ptosis and levator function, presence of uni- or bilateral ptosis, as well as the preference of the surgeon. Surgical techniques include levator resection, brow suspension, frontalis flap, Muller’s muscle conjunctival resection, and posterior-approach levatorpexy. Autogenous fascia lata harvested from the patient’s thigh remains the gold standard for brow suspension, but other materials are commonly utilized, these including silicone rod, Gore-Tex, Mersilene® mesh, Supramid® monofilament, nylon, Prolene, and banked fascia lata. Underlying systemic disorders must be identified in patients with blepharophimosis syndrome, Horner’s syndrome, congenital III nerve palsy, congenital cranial dysinnervation disorders, and neurofibromatosis. In patients with Marcus Gunn jaw-winking ptosis, if the aberrant movement is evident, it can be corrected by levator excision and brow suspension or frontalis flap, preferably performed bilaterally to achieve better symmetry. Recent studies help to define the proper timing of surgical intervention and the ideal surgical techniques to provide adequate long-term results for affected patients.