International Ophthalmology

, Volume 39, Issue 9, pp 1931–1938 | Cite as

Surgical intervention for paediatric blepharoptosis: a 6-year case series

  • Aaron JamisonEmail author
  • Ewan G. Kemp
  • Suzannah R. Drummond
Original Paper



To present our experience of paediatric blepharoptosis in a tertiary referral centre and evaluate the effectiveness of surgical intervention.


A retrospective cohort study of all children receiving surgical blepharoptosis correction between 1/1/10 and 29/2/16. Children with pre-operative levator function (LF) ≥ 7 mm received levator resection, those with LF ≤ 4 mm received brow suspension, and in those children with LF of 5–6 mm, either levator resection or brow suspension was chosen depending on the degree of frontalis recruitment.


Ninety-five children (109 eyes, 64 boys) underwent blepharoptosis surgery within the study period. Mean (range) age at surgery was 5.9 (1.2–12.5) years. Seventy-nine (83.2%) had simple levator maldevelopment. Fifteen children were excluded due to inadequate follow-up. Of the remaining 80 children, 41 (51.2%) underwent levator resection, 27 (33.8%) underwent fascia lata brow suspension, and twelve (15.0%) underwent mersilene mesh brow suspension. Margin reflex distance-1 was greatest at 6-week follow-up with a small “lid drop” by 6-month follow-up in both the levator resection (0.9 mm pre-operatively, 3.1 mm at 6-week follow-up, 2.6 mm at 6-month follow-up) and fascia lata brow suspension (0.3 mm, 2.5 mm, 2.2 mm) groups. No immediate complications, and only two serious post-operative complications, were noted. One case of residual blepharoptosis was re-operated (fascia lata brow suspension).


Surgical correction of paediatric blepharoptosis is safe and, after an observed lid drop between 6-week and 6-month follow-up (not seen in the mersilene mesh brow suspension group), effect appears to be maintained to 6 months and beyond. Readily accessible orthoptic assessment would help identify children at risk of amblyopia, both pre-operatively and post-operatively.


Paediatric Blepharoptosis Ptosis Levator resection Brow suspension 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.


  1. 1.
    Kumar S, Chaudhuri Z, Chauhan D (2005) Clinical evaluation of refractive changes following brow suspension surgery in paediatric patients with congenital blepharoptosis. Ophthalmic Surg Lasers Imaging 36:217–227CrossRefGoogle Scholar
  2. 2.
    Beneish R, Williams F, Polomeno RC et al (1983) Unilateral congenital ptosis and amblyopia. Can J Ophthalmol 18:127–130Google Scholar
  3. 3.
    Harrad RA, Graham CM, Collin JRO (1998) Amblyopia and strabismus in congenital ptosis. Eye 2:625–627CrossRefGoogle Scholar
  4. 4.
    Oral Y, Ozgur OR, Ackay L et al (2010) Congenital ptosis and amblyopia. J Pediatri Ophthalmol Strabismus 47(2):101–104CrossRefGoogle Scholar
  5. 5.
    Griepentrog GJ, Diehl N, Mohney BG (2013) Amblyopia in Childhood Eyelid Ptosis. Am J Ophthalmol 155(6):1125–1128CrossRefGoogle Scholar
  6. 6.
    Berry-Brincat A, Willshaw H (2009) Paediatric blepharoptosis: a 10-year review. Eye 23:1554–1559CrossRefGoogle Scholar
  7. 7.
    Lee V, Konrad H, Bunce C et al (2002) Aetiology and surgical treatment of childhood blepharoptosis. Br J Ophthalmol 86:1282–1286CrossRefGoogle Scholar
  8. 8.
    Pavone P, Mackey DA, Parano E et al (2010) Blepharoptosis in children: our experience at the light of literature. Clin Ter 161(3):241–243Google Scholar
  9. 9.
    Mulvihill A, O’Keefe M (2001) Classification, assessment, and management of childhood ptosis. Ophthalmol Clin N Am 14(3):447–455CrossRefGoogle Scholar
  10. 10.
    Whitehouse GM, Grigg JR, Martin FJ (1995) Congenital ptosis: results of surgical management. Aust N Z J Ophthalmol 23:309–314CrossRefGoogle Scholar
  11. 11.
    Fox SA (1966) Congenital ptosis II. Frontalis sling. J Pediatr Ophthalmol 3:25–28Google Scholar
  12. 12.
    Crawford JS (1956) Repair of ptosis using frontalis muscle and fascia lata. Trans Am Acad Ophthalmol Otololaryngol 60:672–678Google Scholar
  13. 13.
    Holladay JT (1997) Proper method for calculating average visual acuity. J Cataract Refract Surg 13:388–391Google Scholar
  14. 14.
    Collin JRO (1989) A manual of systemic eyelid surgery, 2nd edn. Churchill Livingstone, EdinburghGoogle Scholar
  15. 15.
    Kemp EG, MacAndie K (2001) Mersilene mesh as an alternative to autogenous fascia lata in brow suspension. Ophthal Plast Reconstr Surg 17(6):419–422CrossRefGoogle Scholar
  16. 16.
    Mokhtarzadeh A, Harrison AR (2015) Controversies and advances in the management of congenital ptosis. Expert Rev Ophthalmol 10(1):59–63CrossRefGoogle Scholar
  17. 17.
    Berlin AJ, Vestal KP (1989) Levator aponeurosis surgery. A retrospective review. Ophthalmology 96:1033–1036CrossRefGoogle Scholar
  18. 18.
    Iljin A, Loba A, Omulecki W et al (2003) Congenital blepharoptosis: part I. Evaluation of the results of surgical treatment for congenital blepharoptosis. Acta Chir Plast 45:8–12Google Scholar
  19. 19.
    O’Reilly J, Lanigan B, Bowell R et al (1998) Congenital ptosis: longterm results using stored fascia lata. Acta Ophthalmol Scand 76:346–348CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Tennent Institute of OphthalmologyGartnavel General HospitalGlasgowScotland, UK
  2. 2.Ophthalmology DepartmentRoyal Hospital for ChildrenGlasgowScotland, UK

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