Identifying congenital vs. acquired ptosis guides surgical management
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KOLOA, Hawaii — For ophthalmologists who want to learn about ptosis, it is “the hardest easy thing to deal with,” Eli L. Chang, MD, said at Hawaiian Eye 2023.
“Most of the work is done in the workup, but for some reason patients are really sensitive to having just a little bit of ptosis, so it’s the thing that’s probably the easiest surgery but the one that gets the most complaints for me,” he said.
The initial evaluation determines the route of therapy, and one step is to determine whether the cause is congenital or acquired.
“There are different causes of congenital vs. acquired,” Chang said. “You're going to have to figure this out before you do any kind of surgery.”
Family history is a common presentation of patients with congenital ptosis and most cases are localized to one muscle, he said.
Other signs include poor or absent lid crease formation, eye lid lag when the patient looks down, diminished levator function and ocular motility abnormalities.
“For acquired ptosis, again, you want to deal with the history,” such as onset, alleviating or aggravating factors, family history, recent Botox injections, history of trauma or ocular surgery, and contact lens use, Chang said.
“It's all about figuring out what kind of ptosis they have and how we are going to fix it,” Chang said. “Don’t shortcut the workup.”
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Chang EL. Whosis ptosis diagnosis? Presented at: Hawaiian Eye 2023; Jan. 14-20, 2023; Koloa, Hawaii.
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