Congenital Blepharoptosis: The Influence of Comorbid Pathology on the Results of Surgical Treatment

Introduction. Congenital blepharoptosis represents a significant ophthalmoplastic pathology that substantially impacts the quality of life for patients and their families. Epidemiologically, blepharoptosis frequently coexists with other pathological conditions, predominantly of neurological origin. The presence of concomitant pathologies may considerably influence both surgical strategy and postoperative results.

Objective. To evaluate the impact of somatic pathology on the severity of congenital blepharoptosis in pediatric patients and on surgical outcomes. 

Materials and methods. A retrospective analysis was conducted on 113 pediatric patient records who underwent surgical correction of congenital blepharoptosis of varying severity. Patients were divided into two groups: somatically healthy (n = 90) and with concomitant somatic pathology (n = 23), including congenital cardiovascular, renal, or central nervous system anomalies. Criteria for preoperative surgical planning included: unilateral or bilateral ptosis, degree of ptosis, levator muscle function (LMF), margin-reflex distance 1 (MRD1), palpebral fissure width at the pupillary center, lateral and medial limbus, presence of lagophthalmos, height and presence of eyelid crease, and involvement of accessory muscles (e.g., brow mobility). Surgical interventions comprised levator resection and superior tarsal muscle resection. Postoperative follow-up was performed inpatient on days 1, 3, and 7, and outpatient at 1, 3, 6, and 12 months. 

Results. In the somatically healthy group, unilateral blepharoptosis predominated, whereas bilateral involvement was more common in the group with somatic pathologies. Statistical analysis revealed a significant correlation between bilateral blepharoptosis and the presence of somatic comorbidities (p = 0.025). Analysis of ptosis severity noted significant differences: grade 3 ptosis was observed in 51.43 % of the second group compared to 28.07 % in the first. Concomitant ophthalmic conditions were distributed as follows: amblyopia (28.89 % in group I and 39.13 % in group II), astigmatism (34.44 % and 47.83 %, respectively), and strabismus (esoor exotropia) in 20.00 % and 17.39 %. The operative time was notably longer in group II: average levator resection duration was 53.7 minutes versus

36.2 minutes in group I, with ICU stay averaging 23.6 minutes versus 16.2 minutes. Unsatisfactory outcomes necessitating reoperation were recorded in 23.33% of group I and 30.43% of group II, with no cases of persistent lagophthalmos. 

Conclusion. The presence of concomitant somatic pathology in pediatric patients with congenital blepharoptosis necessitates meticulous preoperative evaluation in a multidisciplinary hospital setting, with a high level of anesthetic support to optimize surgical planning and outcomes.

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