Cases Of Congenital Ptosis Research Articles

The prevalence of refractive errors and corneal topographic changes in unilateral congenital ptosis versus the fellow eye- A cross-sectional study

The drooping upper eyelid in ptosis induces pressure on the eyelid and the same has been implicated to induce refractive errors. Very limited literature is available on the actual prevalence of corneal topographic changes and refractive errors seen in ptosis.Aim of this study was done to examine the effect of pressure of the upper eyelid on refractive errors and corneal topography in ptotic eyes and its comparison with fellow normal eyes. This was a cross-sectional observational study and included 83 patients with unilateral congenital ptosis. The study was conducted at NavJyoti Eye Hospital, Gorakhpur, Uttar Pradesh from Jul 2021- Feb 2023. Only unilateral cases of simple congenital ptosis were included in the study. Ptosis was evaluated to classify it into mild, moderate and severe. Retinoscopic refraction and corneal mapping for topography were done to get keratometric data, refractive errors, astigmatism and topographic patterns. The observations in ptotic eyes were compared with those in fellow normal eyes. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. P- value of < 0.05 was considered significant. Around 18 (21.69%) patients were found to have mild ptosis, 30 (36.14%) showed moderate and 35 (42.17) participants had severe ptosis. 16 (19.28%) ptotic eyes had myopia as compared to 10 (12.05%) non-ptotic eyes. 14 (16.86%) ptotic eyes were hyperopic as compared to 2 (2.41%) non-ptotic eyes. 38 (45.78%) ptotic eyes showed significant astigmatism (refractive) as compared to 5 (6.02%) non-ptotic eyes. 48 (57.83%) of ptotic eyes had significant Sim K (topographic) astigmatism as compared to 24 (28.92%) non-ptotic eyes. The prevalence of refractive errors was found to increase with the severity of ptosis. The majority of ptotic eyes 44 (53.01%) showed symmetrical bow tie pattern on corneal imaging (topography) whereas the most common pattern seen in non-ptotic eyes was round 33 (39.76%). Pressure from the upper eyelid in congenital ptosis induces significant corneal topographic changes and errors of refraction. Meticulous refraction and corneal topography should be done in all cases of congenital ptosis to timely detect astigmatism and suitable corrective measures should be instituted to prevent the development of amblyopia.

The Association between Refractive Errors and Congenital Ptosis

Abstract Background: Children with congenital ptosis need to be carefully assessed for refractive errors and visual function to identify and treat amblyopia which occurs in 20% of congenital ptosis, small amount of which is attributed to ptotic eyelid occluding the pupil. Objectives: The objective is to determine the frequency of refractive errors and its associations among children with congenital ptosis. Patients and Methods: Case–control study of 60 patients with congenital ptosis (79 eyes) and 60 patients without ptosis (control group) (72 eyes). Conducted in Ibn Al-Haithem Eye Teaching Hospital in Baghdad from April 2020 to May 2021. The main outcome measures were relative congenital ptosis, presence, and types of refractive errors. Results: Significant association was obtained between children with ptosis and average spherical and cylinder refractory error. Among 60 cases (79 eyes) of congenital ptosis, refractive errors were present in 26 eyes (32.9%) with the astigmatisms as the most common refractive errors (18.9%), followed by hypermetropia (8.9%) and myopia (5.1%). Conclusions: Children with congenital ptosis in our environment have greater refractive errors, early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.

Marcus Gunn jaw-winking syndrome: A case report

Abstract Marcus Gunn jaw wink phenomenon or Trigeminal oculomotor synkinesis, is a congenital disorder in which the upper lid moves synkinetically in response to jaw movement during chewing. The term synkinesis describes the simultaneous movement or a coordinated sequence of movements of muscles, which are supplied by different nerves or by separate peripheral branches of the same nerve. Although it rarely manifests bilaterally, it is typically unilateral. In 1883, Dr Robert Marcus Gunn, a Scottish Ophthalmologist described a 15-year-old girl with a peculiar type of congenital ptosis that included an associated winking motion of the affected eyelid on the movement of the jaw. It is known to affect both men and women equally. This phenomenon has been reported to be a similar phenomenon affecting 2-13% of all cases of congenital ptosis. It can be congenital or acquired, for example through trauma. The Congenital Marcus Gunn jaw wink phenomenon is thought to arise from the connection between the branch of the trigeminal nerve (responsible for chewing) supplying the middle or lateral pterygoid muscle and the branch of the oculomotor nerve supplying the upper superior levator ocular defect. Here we present a case report of Marcus Gunn’s Jaw-Winking Synkinesis in congenital ptosis.

The Recurrence of Ptosis after Correction Surgery Is Associated with Refractive Error

Background and objectives: Previous studies on ptosis recurrence after correction surgery have tended to focus on postoperative complications, surgical methods and suspension materials, few have mentioned refractive error. This research is to investigate the potential relation between refractive error and recurrence after correction surgery in pediatric patients with simple congenital ptosis. Materials and Methods: We conducted a retrospective analysis of data from patients with simple congenital ptosis who were treated at Zhongshan Ophthalmic Center (ZOC) between 2017 and 2020. In total, 111 eyelids of 85 patients without surgery-related complications who underwent frontalis muscle flap suspension (FMFS) for simple congenital ptosis were included. Postoperative changes in eyelid height were assessed. Cycloplegic refraction was assessed before surgery and during the follow-up period (every 3 months after surgery). Recurrence in the postoperative period was defined as a marginal reflex distance 1 (MRD1) of <1 mm. Results: There were 16 recurrence and 69 non-recurrence cases, with no statistically significant differences, in terms of patient age at the time of surgery, patient sex, or preoperative MRD1, between the recurrence and non-recurrence groups. The postoperative cylindrical diopter (adjusted odds ratio [OR] = 0.432, p = 0.005), laterality (adjusted OR = 0.202, p = 0.006), and preoperative MRD1 (adjusted OR = 0.617, p = 0.019) were associated with ptosis recurrence after surgery. Differences between the recurrence and non-recurrence groups in spherical diopter and spherical equivalent (SE) before and after surgery were not statistically significant. In addition, preoperative refractive error and postoperative spherical diopter were not significantly associated with ptosis recurrence after correction surgery. Conclusions: Ptosis recurrence after FMFS in pediatric cases of congenital ptosis is associated with refractive error. Timely refractive correction and amblyopia treatment may help to reduce ptosis recurrence.

BILATERAL CONGENITAL PTOSIS WITH CONGENITAL FIBROSIS OF EXTRAOCULAR MUSCLES (CFEOM) IN MONOZYGOTIC TWINS

Cases of congenital ptosis are rare, that too occurring in twins. We are presenting a case of mono zygotic twins with bilateral ptosis with congenital fibrosis of extraocular muscles (CFEOM). A 5-year-old boy child and his twin brother who are monozygotic twins presented with bilateral ptosis. Both children had been diagnosed as having congenital fibrosis of extraocular muscles (CFEOM). Parents have refused surgical intervention for the extraocular muscle weakness. They were advised, if the twins complained of any visual abnormality, they should be brought to the ophthalmologists for further assessment.

Congenital ptosis - A clinical and demographic study in a tertiary eye care hospital

Congenital ptosis - A clinical and demographic study in a tertiary eye care hospital - IJOOO- Print ISSN No: - 2581-5024 Online ISSN No:- 2581-5016 Article DOI No:- 10.18231/2581-5016.2018.0040, IP International Journal of Ocular Oncology and Oculoplasty-IP Int J Ocul Oncol Oculoplasty

A Rare Case of Twins with Bilateral Congenital Ptosis – A Case Report

Cases of congenital ptosis are rare, let alone bilateral and occurring in twins. There are many diagnostic dilemmas, often needing genetic testing and advanced imaging such as magnetic resonance imaging.This case report will look at the case of a twin with this interesting feature who are presented to a primary care clinic. It will center around how the diagnosis of congenital fibrosis of extraocular muscles was reached and what management options are available for this twin.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 142-144

Transconjunctival levator muscle plication in mild to moderate congenital ptosis

Purpose The aim of this study was to evaluate the efficacy, cosmetic result, and safety of transconjunctival plication of the levator muscle in the correction of simple congenital ptosis.Patients and methods This is a prospective interventional study that was performed on 23 eyelids (17 unilateral and three bilateral) of 20 patients with simple congenital ptosis and fair to good levator muscle function. All patients were subjected to transconjunctival levator plication. Preoperative history taking and ophthalmological examination were performed. Degree of ptosis was evaluated using the marginal reflex distance 1 (MRD1). Levator muscle function was evaluated using the Berke’s method. Serial follow-up was performed for all patients.Results The mean age of the patients was 6.65±3.13 years. Anatomical success (MRD1 of 3–5 mm and intereyelid difference of <1 mm) was achieved in 20 (86.96%) eyelids, whereas undercorrection occurred in three (13.04%) eyelids. A good cosmetic outcome was obtained in 21 (91.3%) eyelids. A statistically significant improvement was found between the preoperative MRD1 values and the 1- and 6-month postoperative values (P<0.001). There was no significant difference between MRD1 at 1 and 6 months, postoperatively (P=0.07). No major postoperative complications were reported.Conclusion Levator plication using the posterior transconjunctival approach is safe and effective for correcting simple congenital blepharoptosis with a good cosmetic outcome. This technique is especially useful for mild and moderate cases of congenital ptosis associated with good to fair levator muscle function.

Small-incision levator resection for correction of congenital ptosis: a prospective study.

To determine the rate of success of small-incision levator resection technique for correction of congenital ptosis. Patients with congenital ptosis who were candidates for levator resection were enrolled if their levator function was not poor (< 5mm). Incisions were made on upper eyelid crease with a length of 10-12mm. After resection of adequate length of levator muscle, two sutures were used to fix it to tarsal plate. Sliding the incision to medial and lateral sides provided a wider field of access to allow the surgeon to place the sutures above nasal and temporal borders of limbus. Success was defined as margin reflex distance-1 (MRD-1) ≥ 3mm and inter-eyelid difference of MRD-1 less than 1mm, which was considered excellent if inter-eyelid difference was < 0.5mm and good if the latter parameter was between 0.5 and 1mm. Fifty eyes of 47 congenital ptosis cases (16 males and 31 females) were included. Average age was 21.7 ± 9.7years (range, 3-44years). Mean preoperative levator function and MRD-1 were 11.26 ± 2.79 and 1.78 ± 0.92mm, respectively, while postoperative MRD-1 increased to 3.95 ± 0.82mm (P < 0.001). The result was failure (undercorrection) in 12 cases (25.5%), good in 9 patients (19.2%), and excellent in 26 cases (55.3%). Small-incision levator resection has previously been studied for correction of aponeurotic ptosis and proved to yield successful outcome. The findings of this study suggest that small-incision technique can be effectively used in correction of congenital ptosis, as well.

Hering's Law in Congenital Ptosis: Evaluation of the Contralateral Response to Unilateral Congenital Ptosis Repair.

To determine the applicability and clinical relevance of Hering's law for the eyelids in cases of congenital ptosis. A retrospective chart review and digital photograph analysis of patients who underwent unilateral congenital ptosis repair at a tertiary, university-based, Oculoplastics clinic was conducted. Pre- and postoperative eyelid height (marginal reflex distance), upper eyelid symmetry, and brow position were determined using ImageJ analysis software. Changes in these values, and the relationship between the change in ipsi- and contralateral eyelid heights and brow positions, were determined. In 51 patients, the mean change in contralateral upper eyelid position (marginal reflex distance) following unilateral repair was -0.5 mm with 29% (n = 15) demonstrating a greater than 1 mm contralateral descent. The contralateral brow position remained stable with a mean change of +0.1 mm. No significant differences were seen between the 15 patients who demonstrated a contralateral upper eyelid descent greater than 1 mm and the remainder of the cohort in terms of amblyopia rate (p = 0.71), mean preoperative marginal reflex distance (p = 0.14), mean change in ipsilateral marginal reflex distance (p = 0.32), mean change in contralateral brow position (p = 0.44), or mean postoperative upper eyelid asymmetry (1.3 mm vs. 1.2 mm). Overall, the mean upper eyelid asymmetry improved from 2.6 mm preoperatively to 1.2 mm postoperatively. None of the 51 patients underwent subsequent contralateral ptosis repair. Hering's law for the eyelids applies to cases of congenital ptosis but has little clinical significance due to improved upper eyelid asymmetry following unilateral surgery.

Reply re: "Marcus Gunn Jaw-Winking Syndrome: A Comprehensive Review and Report of Four Novel Cases".

To report 4 cases of Marcus Gunn jaw-winking synkinesis (MGJWS) in the absence of ptosis. A retrospective review of patients with MGJWS and congenital ptosis was compiled from the public and private subspecialty adult and pediatric oculoplastic practices of the 2 senior authors (AAM, TGH). Clinical data collected on patients with MGJWS included visual acuity, stereopsis, ocular motility, side of jaw-wink, presence or absence of ptosis, levator function, clinical photographs and videos, and any management undertaken. A total of 848 cases of congenital ptosis were seen. Of these, there were 72 consecutive patients with MGJWS, of which 4 cases (5.6%) had no ptosis. One patient had bilateral MGJWS, with ptosis on one side only. The authors found the incidence of MGJWS in our study population to be 8.5% of all congenital ptosis cases. When the authors excluded syndromic, neurogenic, and myopathic causes of congenital ptosis, the incidence was 12.1%. In addition, the authors found a trend toward females with simple congenital ptosis and MGJWS being affected on the left side, however this was not statistically significant. The authors report the first case series of MGJWS in the absence of ptosis within the second largest series ever reported. These findings may help further our understanding of the etiology behind MGJWS.

Ultrasound biomicroscopy image patterns in normal upper eyelid and congenital ptosis in the Indian population.

Purpose:To study the features of upper eyelid in healthy individual and different types of congenital ptosis in the Indian population using ultrasound biomicroscopy (UBM).Methods:This was a prospective observational study at a tertiary care center. Eyelid structure of healthy individuals with no eyelid abnormalities (n = 19); simple congenital ptosis (n = 33) cases; Marcus Gunn jaw-winking ptosis (MGJWP, n = 7) cases, and blepharophimosis-ptosis-epicanthus inversus syndrome (BPES, n = 20) cases were studied on a vertical UBM scan using 50-MHz probe. Lid-thickness, tarsal-thickness, orbicularis oculi and levator-Muller-orbital septum-conjunctival (LMSC) complex were measured in primary gaze. Comparison was made between four groups and results were statistically analyzed using ANOVA test. In normal individuals, LMSC measurements were repeated in down-gaze imaging.Results:Skin with subcutaneous tissue, LMSC complex and pre-aponeurotic fat-pad appeared echodense while orbicularis oculi and tarsus appeared echolucent. In primary gaze, mean thickness (± standard deviation) of the eyelid, tarsus, orbicularis oculi and LMSC, respectively, were: 1.612 ± 0.205, 0.907 ± 0.098, 0.336 ± 0.083, and 0.785 ± 0.135 mm in normal individual. LMSC showed 46.64% increase in thickness on down-gaze. The mean eyelid thickness and LMSC were thicker in MGJWP and BPES as compared to normal. In different types of congenital ptosis cases, various patterns of UBM imaging were observed.Conclusion:UBM allows noninvasive imaging of eyelid structures with good anatomical correspondence in normal eyelids and study the structural alterations of eyelids in different types of congenital ptosis. UBM can be used to highlight the anatomical difference in normal eyelids that may help modify the surgery for better cosmetic outcomes. Furthermore, it has the potential to be used in preoperative evaluation and operative planning in certain types of acquired ptosis, which needs to be evaluated.

Technique de suspension au ligament de Whitnall dans le traitement chirurgical du ptosis

We report our experience in ptosis surgery using the technique of Whitnall's ligament suspension in congenital ptosis. A retrospective study of 20 cases of congenital ptosis treated by the technique of Whitnall's ligament suspension, 8 by the posterior approach and 12 by the anterior approach. Patients were randomized into 3 groups according to upper eyelid levator function. Postoperative follow-up was obtained on day 1, one week, one month, three months and one year. All patients had good correction; 3 had an under-correction as a three-month final result, of which only one required reoperation for an unsatisfactory result. There was no abnormal curvature of the lid margin or malposition of the lid crease. All lids required initial over-correction, which yielded a good end result. The success rate was 85%. The technique of Whitnall's ligament suspension for the treatment of ptosis has rarely been described in the literature, but the few studies reported show its equivalence in terms of results to other surgical techniques for treatment of ptosis and also confirm its superiority in terms of respect for anatomy and physiology of the eyelid. This technique is particularly suited to the treatment of congenital ptosis with moderate levator function, and the results are promising.

Evaluation of transconjunctival levator tucking for congenital ptosis

Purpose The purpose of this paper is to evaluate the efficacy, cosmetic results, and safety of transconjunctival tucking of the levator aponeurosis for correction of simple congenital ptosis. Patients and methods This was a prospective interventional noncomparative case-series study. This study was carried out at the Ophthalmology Department of Minia University Hospital. Thirty eyelids of 24 patients with simple congenital ptosis with fair to good levator muscle function (≥5 mm lid elevation) were subjected to transconjunctival tucking of levator aponeurosis. All patients were subjected to an assessment of history and a full ophthalmological examination. The degree of ptosis was evaluated using marginal reflex distance 1. Levator muscle function was evaluated while fixing the eyebrow. Preoperative and postoperative digital photographs were used for documentation. Results Anatomical success was achieved in 26 (86.7%) eyelids. Undercorrection was present in four (13.3%) eyelids. No case of overcorrection was encountered. Undercorrection was associated with more severe ptosis and less levator muscle function. Good cosmetic outcomes were obtained in the majority of cases. Apart from undercorrection, no significant postoperative complications occurred during the study. Conclusion Levator aponeurosis tucking using the posterior transconjunctival approach is safe and effective for correcting simple congenital blepharoptosis, with good cosmetic outcomes. This technique is especially useful for mild and moderate cases of congenital ptosis associated with fair to good levator muscle function.

Is Hering's Law as Important in Congenital Blepharoptosis as in Acquired Ptosis?

Although Hering's law has significant importance in the planning and outcomes of eyelid surgery, it has not been applied in all cases of ptosis. The authors evaluate whether cases of unilateral congenital ptosis require surgery on the contralateral eyelid, in keeping with Hering's law. The records of 35 consecutive patients with unilateral congenital ptosis who had surgical repair between 2007 and 2012 were retrospectively analyzed. All patients underwent either levator resection or frontalis sling surgery. Preoperative and postoperative clinical documents and photographs were evaluated for each case, including preoperative Hering's dependence and postoperative measurements of the change in position of the nonoperated eyelid. There were 19 women and 16 men, and the average patient age was 9.7 ± 10 years. The mean preoperative levator function and marginal reflex distance were 6.7 ± 4.7 mm and 0.3 ± 0.47 mm, respectively. There were significant differences in age, preoperative levator function, and marginal reflex distance between patients who underwent levator resection and those who had frontalis sling surgery. In all patients, the preoperative Hering's dependence of eyelid position did not show any decrease, and the position of the contralateral eyelid postoperatively did not differ from the baseline position. This research shows that Hering's law does not apply to cases of congenital ptosis. This is likely due to the fibrotic levator palpebrae muscle and its special innervations. Thus, it is not necessary to perform levator resection or a frontalis sling operation on the unaffected eyelid.

Prospective Audit of Ptosis Surgery at the Singapore National Eye Centre

To evaluate the demographics, presentation, and surgical outcomes of patients undergoing ptosis surgery in an Asian population in a prospective manner. A prospective ptosis audit was conducted over a 2-year period from January 2010 to December 2011 in a tertiary eye hospital in Singapore. All patients undergoing ptosis surgery by, or under the supervision of, an oculoplastic-trained consultant in the institution were included. Institutional Review Board approval was obtained for the study. This study comprises 302 patients, of which 236 were acquired and 66 were congenital ptosis cases. Levator repair (77.2%) was the most commonly performed procedure, followed by levator resection (13.9%) and brow suspension (8.9%). Forty-seven (10.1%) eyes had readjustment within 2 weeks, the reasons for readjustment being eyelid height undercorrection (n = 35), eyelid height overcorrection (n = 9), and unsatisfactory eyelid contour (n = 4). Postoperatively, 93.8% of patients showed an increase in marginal reflex distance-1 (MRD1), 91.3% achieved symmetry or <1 mm of asymmetry in MRD1, 98.5% had good eyelid contour, and 74.3% had symmetric eyelid crease. On a scale of 1 to 10, 83.1% of patients gave a subjective grade of 7 or better. This study is the first prospective ptosis surgery audit in an Asian population and takes a leading step in assessing both subjective and objective surgical outcomes in a prospective manner. With the continuation of this audit in years to come, it will allow us to generate clinical outcomes in a robust manner and allow for more reliable benchmarking with major centers elsewhere.

Clinical experience of surgical correction of congenital ptosis

Objective To evaluate the clinical efficacy of different surgical procedures in the management of congenital ptosis.Methods 128 eyes of 81 cases of congenital ptosis were recruited in the study who were treated in our hospital from March 2007 to December 2011.Selection of surgical procedures depended on age,the degree of levator muscle function and the degree of frontalis function.Frotalis sling was performed in 46 eyes of 28 cases.82 eyes of 53 cases underwent levator resection.Postoperative satisfactory rate and surgical complications were analyzed.Results The total effective rate was 94.53％ in all cases.76.56％ patients (98 eyes) were satisfied with the surgical results and 17.97％ cases (23 eyes) were rated as acceptable.5.47％ (7eyes) cases were not satisfied with the surgical results.No severe surgical complications were observed.Conclusion Either frontalis shng or levator resection is ideal choice for surgical correction of congenital ptosis. Key words: Ptosis, congenital; Frontalis sling; Levator resection

Perfil epidemiológico dos pacientes com ptose congênita no hospital regional de São José

PURPOSE: To draw an epidemiological profile of congenital ptosis patients in the Hospital Regional de São José (HRSJ), describing the general characteristics of congenital ptosis, including the coexistence of strabismus and the prevalence of amblyopia. METHODS: An epidemiological study with a cross-sectional characteristic was conducted, based on analysis of medical records of congenital ptosis cases treated on the Department of Ocular Plastic and Orbit of the HRSJ, from July 1998 to July 2008. RESULTS: A total of 42 patients (56 [...]

Incidence and Demographics of Childhood Ptosis

To report the incidence and demographics of childhood ptosis diagnosed over a 40-year period in a well-defined population. Retrospective, population-based cohort study. Patients (<19 years) diagnosed with childhood ptosis and residents of Olmsted County, Minnesota, from January 1, 1965, through December 31, 2004. The medical records of all potential patients identified by the Rochester Epidemiology Project were reviewed. Calculated annual age- and gender-specific incidence rates and demographic information. A total of 107 children were diagnosed with ptosis during the 40-year period, yielding an incidence of 7.9 per 100000 younger than 19 years (95% confidence interval [CI], 6.4-9.5). Ninety-six (89.7%) of the 107 had congenital-onset disease. Eighty-one (75%) of the 107 had simple congenital ptosis, yielding a birth prevalence of 1 in 842 births. A family history of childhood ptosis was present in 12% of queried patients with simple congenital ptosis. Three (4%) of the simple congenital ptosis cases were bilateral and 55 (68%) of the unilateral cases involved the left upper eyelid (95% CI, 57%-78%; P<0.001). Childhood ptosis was diagnosed in 7.9 per 100000 patients younger than 19 years (95% CI, 6.4-9.5). Simple congenital ptosis was the most prevalent form, occurring in 1 in 842 births, and was significantly more likely to involve the left side. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Refractive Error, Srabismus and Amblyopia in Congenital Ptosis

Congenital ptosis is often associated with visual impairment. The aim of the study is to find out the pattern of refractive error, strabismus and amblyopia in patients with congenital ptosis in a hospital setting. This is a hospital based prospective and descriptive study conducted at Tribhuvan University, B P Koirala Lion's Centre for Ophthalmic studies in Nepal from February 2003 to July 2004. All the consecutive cases with congenital ptosis were included and cases with pseudoptosis were excluded from the study. Among the 78 cases (95 eyes) of congenital ptosis, refractive error was present in 13 cases (16.7%) with astigmatism as the commonest refractive error (8.9%). Strabismus was found in 23 cases (26.9%) of congenital ptosis. Among the strabismus, combined exotropia with hypotropia was found in the majority of cases (16.7%). Visual impairment due to amblyopia was found in 15 cases (19.2%) of congenital ptosis with mixed strabismic and refractive etiology as the commonest one (46.7%) followed by pure strabismic (26.7%), pure refractive (20%) and stimulus deprivation amblyopia (6.7%). Patients with congenital ptosis have higher rate of amblyopia due to greater prevalence of strabismus and refractive errors although stimulus deprivation amblyopia is less common. Early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.