[Unilateral ptosis in children]
1Service d'ophtalmologie, Hopital Necker Enfants malades, APHP, Université de Paris, INSERM UMRS1138 team 17 Universite Sorbonne Paris Cite, Centre de Références des Maladies Rares en Ophtalmologie OPHTARA.
Insights
Unilateral ptosis in children, often congenital, lowers the upper eyelid and can cause amblyopia. Early diagnosis and treatment, including visual rehabilitation and surgery, are crucial for visual development.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Surgical Science
Background:
- Unilateral ptosis in children is a common congenital condition affecting eyelid position.
- It can impede visual development, potentially leading to amblyopia.
- Distinguishing true ptosis from pseudoptosis, including tumor etiology, is critical.
Purpose of the Study:
- To outline the diagnostic approach for unilateral ptosis in children.
- To describe the key clinical examination components for diagnosis.
- To discuss management strategies, including visual rehabilitation and surgical options.
Main Methods:
- Clinical examination focusing on eyelid height, visual axis, eyelid crease, levator muscle function, Bell's sign, and pupil size.
- Differential diagnosis to exclude pseudoptosis and identify specific etiologies like Horner syndrome or cranial nerve palsy.
- Assessment of visual acuity and potential for amblyopia.
Main Results:
- Congenital ptosis is primarily diagnosed in infants.
- Specific clinical signs aid in identifying the cause and severity.
- Pupillary examination can confirm conditions like Horner syndrome or oculomotor nerve palsy.
Conclusions:
- Early diagnosis of unilateral ptosis in children is essential.
- Comprehensive clinical evaluation guides management decisions.
- Treatment involves visual rehabilitation and surgical intervention, such as levator resection or frontalis suspension.
Abstract:
Unilateral ptosis in children. Childhood ptosis is a common condition, mostly congenital, and of varying severity. It is characterized by a lowering of the upper eyelid. Unilateral it can affect visual development producing amblyopia. Before a unilateral ptosis of the child, pseudoptosis must be eliminated as the etiology can be a tumour. The diagnosis of congenital ptosis is mainly performed in infants. Clinical examination is based on the evaluation of the eyelid height and the visual axis, eyelid crease, the levator muscle function, Charles Bell sign and the pupil size. Some more common etiologies such as Claude Bernard Horner syndrome or oculomotor cranial nerve palsy may be confirmed on pupillary examination. Visual rehabilitation therapy should be instituted and surgical management must be planned. The surgery is based on a resection of the levator muscle or a frontalis suspension.
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