Etiology, management of ptosis in working age group and its surgical outcome – A prospective study

Abstract

To study the etiology of ptosis among 20 - 50 years of age and analyse the management and surgical outcomes of various types of ptosis using different surgical modalities. This prospective study was conducted at Tertiary Eye Care centre in Chennai from July 2018 - June 2019.It included all patients with ptosis between the age of 20 - 50 years after excluding vascular malformations and malignant tumours of the lid. Here all variables are described with frequency distribution and displayed using percentage. Incidence of congenital ptosis was 11 cases (37%), aponeurotic ptosis 8 cases (26%), myogenic ptosis 4 cases (13%), neurogenic ptosis 3 cases (10%), mechanical ptosis. 2 cases (7%), post traumatic ptosis 2 cases (7%). 70% were males and the remaining 30% were females. Among 30 cases, 23 patients had unilateral and 7 patients had bilateral ptosis. Moderate ptosis (3-4mm) (46.7%) formed a major composition of our study shortly followed by severe ptosis (43.3%). Out of 30 cases, 9 cases were managed medically (30%) and surgical intervention was required in 21 cases (70%). Out of 7 bilateral ptosis, 2 cases were managed medically and 5 cases needed surgical intervention. Complications following frontalis sling were under correction (27.3%) in 3 cases followed by mild corneal exposure keratitis (9.1%) in one patient. Complications following levator advancement were under correction in one case (12.5%) and mild lid peaking in one case (12.5%). Among 2 cases of mechanical ptosis, one was squamous papilloma and other was a large chalazion. Out of 4 myogenic cases 3 cases were due to myasthenia and the other diagnosed to have CPEO. 2 cases of traumatic ptosis were due to traumatic 3rd nerve palsy and traumatic levator dehiscence. The most common acquired ptosis was aponeurotic followed by myogenic, neurogenic, traumatic and mechanical ptosis. Frontalis sling surgery is the most common surgery done for congenital ptosis. Use of polypropylene as a suspensory material gives a good functional outcome. Aponeurotic advancement surgery is the most common surgery performed for acquired ptosis.