Associated morbidity of pediatric ptosis — a large, community based case–control study

Purpose: To report the incidence, demographics, and associations of various conditions among patients with pediatric ptosis.

Methods: A retrospective, observational case–control study of patients (birth–18 years; n = 2,408) diagnosed with pediatric ptosis in 1/2003–12/2012. Age- and gender-matched control patients (n = 9,632) were randomly selected from the district members. Medical and socio-demographic information were extracted from electronic medical records.

Results: The average age of diagnosis was 5.6 years, and 1,325 (54 %) were male, with an incidence of 19.9/100,000. Systemic conditions significantly associated with pediatric ptosis include myasthenia gravis, congenital anomalies, deafness, mental retardation, muscular dystrophy, neurological diseases, epilepsy, schizophrenia, and malignancy.

Ophthalmic conditions associated with pediatric ptosis include exotropia, progressive external ophthalmoplegia, hypotropia, esotropia, hyperopia, vertical heterophoria, intermitent esotropia, astigmatism, retinopathy, internuclear ophthalmoplegia, and myopia. Symptoms of diplopia, blurred vision, and aniseikonia were significantly more common.

Conclusion: Pediatric ptosis is associated with various systemic and ophthalmic conditions, and many are diagnosed after the age of 5 years. Clinicians should maintain a high degree of suspicion and thoroughly evaluate all patients with pediatric ptosis to properly assess underlying systemic associations. A better understanding of the patho-physiological association between these factors and pediatric ptosis may help its prevention and treatment.