Untitled Congenital Ptosis Congenital ptosis is a primary localized dystrophy of the levator muscle and may be unilateral or bilateral. Histologic examination of affected eyelids shows a decrease in the number of striated muscles fibers and replacement with fibrous tissue. Clinical Characteristics Parents will often comment that the eye looks smaller due to the drooping eyelid. There is a decreased or absent lid crease where the levator muscle would normally insert below the skin surface. If the ptosis is severe, the child will often attempt to raise the lid by lifting their brow or adapt a chin-up head posture to maintain binocular vision.
Surgical treatment is determined by the amount of levator function that is present.
A levator resection may be used in children with moderate to good function. In patients with poor or absent function, a frontalis suspension procedure may be necessary. This technique requires the use of a suspension material to be placed between the frontalis muscle and the tarsus of the eyelid. It allows the patient to more effectively use their brow and frontalis muscle to raise their eyelid. Suspension materials that may be used include suture, silicone rods and fasia lata, either cadaver or autologous.