Oculomotor Imbalance in Congenital Ptosis

Summary

We report the presence of against the rule vertical imbalances in several cases of unilateral or bilateral congenital ptosis possibly having a postural pathogenetic mechanism, causing a binocular dissociation that could be the origin of numerous so-called non-related Strabismus (eso or exotropias).

Burke (1949) and Anderson (1980) report the high incidence of Strabismus in patients with congenital ptosis, stressing the need for a careful examination of all ptotic patients to detect any form of oculomotor imbalance.

We report some forms of oculomotor imbalance not previously mentioned by either author.

In Anderson’s series of 113 congenital ptosis, the overall incidence of strabismus is 32%, slightly higher than that of Burke (26.5%).

It is interesting to note that only 44% of these strabismus could be described as in association with ptosis: 6 cases of double elevator palsy, 4 cases of jaw-wink ptosis, 3 cases of IIIrd nerve palsy, 3 cases of cyclic IIIrd nerve palsy.

The remaining 56% of ptotic patients had a form of strabismus that could not be considered as an association to the lids condition.

From them 3.5% (3 cases) were considered as consecutive to Ptosis (exotropia developing from visual deprivation by the falling lid).

The rest of the patients had several different forms of strabismus, none of them in apparent relation to the ptosis (3 cases of Hypotropia, 3 cases of Hypertropia, 1 Brown syndrome, 3 Duane syndrome, 1 DVD Syndrome and 3 congenital esotropias).