Children With Ptosis Have Intensified Psychosocial, Mental Health Morbidity

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Youth with congenital ptosis developed a mental health disorder 2.5 times more than others.

Prior studies have shown that wearing eyeglasses or an eye patch can lead to peer victimisation and childhood bullying, and other research highlights appearance-caused stressors for children and adults; so, it may not be surprising that a new investigation finds children with simple congenital ptosis had a 2.5 times greater likelihood of developing a mental health disorder than their peers, according to data published in British Journal of Ophthalmology.

The case-controlled study examines mental health and psychosocial outcomes for 81 children with ptosis, and 80 age- and gender-matched normal individuals who also had medical appointments at 1 of 2 Mayo Clinic-affiliated centers in Olmsted County, Minn. Investigators analyzed charts from Jan. 1, 1965 to Dec. 31, 2004. Mental health disorders are outlined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5).

Children in the case group were diagnosed with ptosis at a mean age of 3.2 years and were followed until 21.4 years of age. Despite no significant differences between case and control groups in family history of psychiatric disease, substance abuse, or prenatal maternal substance abuse, ptosis-impacted kids had a greater risk of adverse psychosocial development (P =.03), as well as chances for a larger number of mental health diagnoses (P =.02), and being prescribed psychotropic medicines for a longer time (P =.007). 

Youth with ptosis were also diagnosed with a DSM-5 mental health illness slightly younger than their peers; 16 vs 20.5 years of age. They were also significantly more likely to display low self-esteem (P =.0001), social anxiety (P =.0002), developmental delay (P =.0006), alcoholism (P =.003), non-productive anger (P =.009), and decreased motivation (P =.04). In the ptosis cohort, 9 of 81 experienced a major depression, compared with 4 of 80 in the control group.

Greater baseline eyelid asymmetry did not significantly raise chances for mental or psychosocial diagnoses. Also, having corrective surgery — or the age at which repair occurred — did not affect risk for morbidity, with the exception of 11 patients for whom there was a mean improvement in fissure height of 2.3 mm. These patients did not acquire DSM-5 or psychosocial disorders, in contrast to 7 children with 0.6 mm change who later developed adverse mental health effects (P =.05). Pre- and post-surgery lid measurements were missing for 16 others who underwent surgery.

While generalized anxiety and major depressions were the most frequent DSM-5 conditions for children with ptosis, these illnesses are also commonly diagnosed in the US, as well as in the current control group. Cases in this study were found using the Rochester Epidemiology Project, a medical records system. Paper and electronic records comprised data from primary care, psychological, psychiatric, and emergency room visits. Limitations of this analysis included its retrospective nature and a non-diverse population-based sample. 

Psychological support can also be important when treating ptosis-affected children. “Children with ptosis may benefit from early psychosocial intervention,” the investigation explains.


Hendricks TM, Griepentrog GJ, Hodge DO, Mohney BG. Psychosocial and mental health disorders among a population-based, case–control cohort of patients with congenital upper eyelid ptosis. Br J Ophthalmol. Published online July 19, 2021. doi:10.1136/bjophthalmol-2021-319276