Ptosis

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Acute ptosis should be referred immediately to the PCH Ophthalmology department. Call PCH switch and ask to speak to the ophthalmology registrar on call.

 

Introduction

Ptosis in children is usually the result of an underdeveloped/ weak levator muscle. It can be unilateral or bilateral, an isolated feature or a component of systemic syndrome or disease process.

If the ptosis is significant the child may compensate by adopting a chin up head posture in order to see. In other cases, an elevated brow position may be a compensatory sign.

The normal position of the upper eyelid is 1-2mm below the upper corneal limbus. Mild ptosis that does not cover part of the pupil generally does not require treatment.

Moderate or severe ptosis that obscures part of or the entire pupil can impact normal visual development and needs to be diagnosed and treated in a timely manner to prevent permanent vision loss.

When to refer

  • Ptosis obscuring or partially obscuring the pupil.
  • Ptosis associated with chin up head posture.
  • Sudden onset ptosis.
  • Ptosis associated with any pupillary asymmetry or abnormal eye movements.
  • Ptosis associated with any suspected mass lesion on the eyelid or orbit. 

How to refer

  • Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
  • Routine non-urgent referrals from optometrists or doctors at private hospitals are made via the PCH Referral Office.
  • Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the opthalmology registrar. 

Essential information to include in your referral

  • History of onset of ptosis i.e., congenital (present since birth) or acquired
  • Pupil examination findings- reaction to light and symmetry
  • Any eye movement abnormality noticed
  • Any family history.

Useful resources

References

  1. Marenco M, Macchi I, Galassi E, Massaro-Giordano M, Lambiase A. Clinical presentation and management of congenital ptosis. Clinical ophthalmology (Auckland, NZ). 2017;11:453-63.
  2. Pavone P, Cho SY, Praticò AD, Falsaperla R, Ruggieri M, Jin D-K. Ptosis in childhood: A clinical sign of several disorders. Medicine. 2018;97(36):e12124.

Reviewer/Team: Dr David Greer, Dr Olivia MacVie,  Professor Geoff Lam, Dr Avenell Chew - Ophthalmology Department, PCH Last reviewed: Nov 2021


Review date: Nov 2022
Endorsed by:

CPAC Date:  Nov 2021


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