Profile and Management of Blepharoptosis Patients in North India - A Two-Year Study

BACKGROUND Blepharoptosis is a relatively common form of eyelid malposition in both children and adults. Along with being a cosmetic blemish, ptosis is associated with high incidence of amblyopia, especially in young children with severe ptosis. This can have a negative impact on psychosocial development of a child. Hence, it becomes necessary for a general physician as well as for a general ophthalmologist sitting at a primary health care centre, to know the clinical profile of such patients. We wanted to study the demography, clinical presentation and management of blepharoptosis patients seen in our institute over a period of 2 years. METHODS 45 patients with ptosis who reported at our tertiary care hospital in North India from January 2017 to December 2018, were included in the study. Demographic data, clinico-etiological profile, management of ptosis including outcome of surgeries performed was analysed retrospectively. Data was presented as frequencies and mean ± standard deviation (SD). RESULTS The study comprised of a total of 45 patients. The mean age of presentation was 17.4 years. Maximum number of patients i.e. 17 (37.7 %) were from the age group 11 - 20 years. Male to female ratio was 2.75 : 1. Congenital ptosis was found to be the most common type seen in 36 (80 %) patients. Simple congenital ptosis (34 patients) being the commonest among congenital type. 4 (17.7 %) patients had aponeurotic ptosis. 3 (6.6 %) patients had neurogenic ptosis. Myogenic ptosis was seen in 2 (4.4 %) patients. Majority of our cases had severe degree of ptosis (57.7 %) and poor LPS action (46.6 %). LPS resection was done in 21 (46.6 %) patients, LPS reinsertion in 1 (2.2 %), sling surgery in 18 (40 %) and Fasanella Servat operation in 1 (2.2 %) patient. 2 (4.4 %) patients were medically managed and 2 (4.4 %) were kept under observation. The outcome of surgery was good in 28 (62.2 %) patients, fair in 7 (15.5 %) and poor in 6 (13.3 %) patients. Presence of amblyopia was noted in 21 patients i.e. 46.7 % of the total patients. Marcus Gunn Jaw winking phenomenon was elicited in 2 (4.4 %) patients. Bell’s phenomenon was found in 4 (8.8 %) patients. 5 (11.1 %) patients had exotropia, 3 (6.6 %) had hypotropia and 1 (2.2 %) patient had complete ophthalmoplegia. CONCLUSIONS The study highlights the demographics, clinical profile and management of congenital blepharoptosis patients seen at a centre of excellence in North India. The study is helpful for ophthalmologists in guiding diagnosis, evaluation and management of such patients and hence, long-term successful outcome of this disease. KEYWORDS Blepharoptosis, Levator Resection, Frontalis Sling Surgery