Congenital ptosis in childhood could increase risk of mental and psychosocial illness

Cohort data were reviewed to evaluate the psychosocial and mental health burden of children with simple congenital ptosis.

Study design

This was a population-based cohort study, conducted in Olmsted County, Minnesota, of 81 patients diagnosed with simple congenital ptosis as children over a 40-year period and their age- and gender-matched controls. The medical records of both groups were reviewed for psychosocial and mental health parameters. The ptosis group was monitored to a mean age of 21.4 years, and the controls to a mean age of 25.1 years.

Outcomes

Adverse psychosocial development was diagnosed in 51% of patients with ptosis and 33% of controls (odds ratio [OR] 2.5], while mental illness was diagnosed in 38% of patients with ptosis and 20% of controls (OR 2.1). Of 18 patients with ptosis who underwent surgery and had pre- and post-operative measurements available, those who did not develop mental or psychosocial illness had a mean fissure increase of 2.5 mm, compared with an 0.6-mm increase in those who had developed mental or psychosocial illness. The most common mental health diagnoses among the children with ptosis were generalized anxiety, major depression, and alcoholism.

Limitations

This is a retrospective study that is limited by incomplete data and irregular follow-up. The sample size is relatively small, which may confound some of the data collected.

Clinical significance

Congenital ptosis not only causes potential problems with vision, but appears to negatively affect the mental health and psychosocial development of children. A successful ptosis surgery appears to positively affect patients. These findings should be taken into consideration in treating patients with congenital ptosis, as early psychosocial intervention may be appropriate in these patients.

Financial Disclosures: Dr. Richard Allen discloses no financial relationships.