Clinical Characteristics and Visual Acuity in Patients with Congenital Ptosis: A Cross-Sectional Study

Background: Congenital ptosis (blepharoptosis) is characterized by drooping of the upper eyelid due to abnormal development or dysfunction of the levator palpebrae superioris. It may affect the visual axis and visual function. Objective: To describe the clinical characteristics and visual acuity of patients with congenital ptosis and assess the association between palpebral fissure height and visual acuity. Methodology: A descriptive cross-sectional study was conducted among 40 patients with congenital ptosis at DHQ Vehari Eye Complex, Pakistan. We recruited participants aged 1-30 years using convenience sampling. We excluded patients with acquired ptosis, previous treatment or surgery, or ocular conditions affecting visual acuity or assessment. Clinical assessment included head posture, extraocular movements, palpebral fissure height, marginal reflex distance (MRD), levator palpebrae superioris function, and visual acuity. The association between palpebral fissure height and visual acuity was analyzed using Pearson’s chi-square test. Results: Among 40 participants, 55.0% were male and 45.0% female; 62.5% were aged 1-10 years, 32.5% 11-20 years, and 5.0% 21-30 years. Normal head posture was present in 95.0%, while full extraocular movements were present in 96.0% of the right and 94.0% of the left eyes. Visual acuity of 6/9-6/12 was observed in 75.0% of the right and 57.5% of the left eyes. Poor levator function was found in 13.0% of the right and 24.0% of the left eyes. Palpebral fissure height and MRD showed variation between the eyes. No significant association was found between palpebral fissure height and visual acuity in the right (p=0.309) or left eye (p=0.105). Conclusion: Congenital ptosis showed variation in eyelid measurements and levator function, while visual acuity was relatively good in most participants. Palpebral fissure height was not significantly associated with visual acuity in either eye. Clinical assessment should therefore combine eyelid measurements and levator function with visual acuity and evaluation of refractive status, ocular alignment, and amblyopia.