Orbital Asymmetry in Congenital Ptosis

Abstract

We report orbital asymmetries associated with congenital ptosis. This was a prospective, observational study enrolling all cases of idiopathic, nonsyndromic congenital ptosis presenting to a tertiary university center between 2023 and 2025. Exophthalmometry was performed using both Hertel and Naugle devices by 2 independent observers. Average intereye differences were calculated. Axial length was measured using optical biometry. Any other nonsyndromic eyelid or periocular findings were noted. N=26 patients were enrolled. Average age was 8.8±8.5 years (range 7 mo-26 y). Exophthalmometry consistently demonstrated relative enophthalmos on the more ptotic side (n=25, 96%), with an average enophthalmos of -1.21±0.47 mm (P<0.001) using the Naugle exophthalmometer, and -1.29±0.49 mm (P<0.001) using the Hertel. There was no difference in axial globe length between ptotic and nonptotic eyes (0.02±0.48 mm, P=0.86). Relative enophthalmos on the ptotic side was independent of differences in axial length (R2=-0.02, P=0.44), age (R2=-0.01, P=0.40), or ptosis severity as judged by levator function (R2=0.02, P=0.20) by multiple linear regression. Associated orbitofacial conditions were observed in 15 patients (58%), and all occurred on the ptotic side. These included NLDO (n=6, 23%), dermoid cyst (n=3, 12%), septal deviation (n=3, 12%), and Marcus-Gunn jaw wink (n=3, 12%). In conclusion, congenital ptosis was reliably associated with relative enophthalmos independent of globe size or ptosis severity, and a high incidence of other oculofacial conditions. These findings complement facial asymmetries previously reported in association with congenital ptosis.

The authors' abstract, as published at the source. Journal of Craniofacial Surgery, 2026 · DOI ↗