The Timing for Diagnosis of Anisometropia in Japanese Children with Congenital Eyelid Ptosis

Purpose: The difference in refractive errors between both eyes, namely, anisometropia, is a known complication in congenital blepharoptosis. This study searched the timing of diagnosis of anisometropia in children with congenital blepharoptosis.
Methods: Retrospective review was made on medical records of 20 consecutive patients with congenital blepharoptosis at Okayama University Hospital from 2004 to 2018.
Results: T he age at the initial visit ranged from 1 month to 5 years 1 month (median, 5.5 months), and the follow-up period from 1 year 8 months to 13 years 5 months (median, 5 years 5 months). Blepharoptosis was on the right side in 6 patients, on the left side in 10, and on both sides in 4. Four patients underwent levator muscle plication at the age ranging from 3 months to 6 years 2 months: One patient on the right side, 2 on the left side, and one on both sides. Nine patients were found to have anisometropia, defined as hyperopic difference of 2 or more diopters between both eyes, or astigmatic difference of 2 or more diopters between both eyes, and astigmatism of 3 or more diopters in both eyes (ametropia), at the age ranging from 1 year 3 months to 3 years 6 months (median, 3 years). Four of the 9 patients with anisometropia showed unilateral amblyopia as the best-corrected visual acuity in decimals ranging from 0.2 to 0.5. The remaining 11 patients without anisometropia had normal levels of visual acuity in both eyes. Anisometropia was found in 3 of 4 patients with surgery and 6 of 16 patients with no surgery (no significant difference at chi-square test).
Conclusion: About a half of children with congenital blepharoptosis was found to have anisometropia at the age of 1 to 3 years. Care must be taken on refraction and glasses prescription at these ages.