Management of congenital blepharoptosis in pediatric patients

Abstract

Introduction: Palpebral ptosis corresponds to the lowered positioning of the upper eyelid margin (MRD1) in primary gaze. The objective of this work is to present the response to surgical treatment of palpebral ptosis operated in the last 3 years. Methods: This was a retrospective study that included pediatric patients less than 15 years old operated for palpebral ptosis at the Pediatric Plastic Surgery Service from 2021 to 2023. We report 13 cases of operated blepharoptosis in 19 eyelids. The variables were MRD1 level in primary gaze pre and postoperative, levator muscle function, cause, associated syndrome, unilateral or bilateral, age, type of surgery (frontal sling vs. levator resection), and complications. Excellent response was defined when symmetric MRD1 was achieved, good response in 1 MRD asymmetry, and poor response in 2 or more MRD1 asymmetry. Results: 7 cases were myogenic, 2 mechanical, 1 neuropathic, and 3 blepharophimosis-ptosis-epicanthus inversus syndrome. The ages at surgery for severe ptosis were 3 months, 6 months and 2 years and the average age for moderate ptosis was 7 years (range 6 months to 15 years). Three patients were resolved with levator muscle advancement and resection and three with frontal sling. In the case of mechanical ptosis, plasty of the scar and resection of the mass was performed with resolution of the ptosis. Ten patients had an excellent response and 3 had good response. One lagophthalmos, hematoma, partial relapse and two entropions were presented as complications. Conclusion: Blepharoptosis is a condition that must be managed in a multidisciplinary way to achieve symmetry in the gaze and reduce related complications. We have observed a good response with the levator muscle resection and frontal sling techniques. Leve of evidence: 4

Keywords

• Blepharoptosis
• Eyelids
• Blepharophimosis