Overview
The authors examined whether congenital ptosis (a droopy eyelid present from birth) is associated with attention-deficit/hyperactivity disorder (ADHD). This retrospective, national, cross-sectional study collected demographic data, ptosis characteristics, surgical details and ADHD diagnoses, made using standardized clinical criteria by ophthalmologists and neurologists.
Findings
- 866 patients with congenital ptosis: 485 male, 381 female; mean age at diagnosis 3.66 years.
- 673 patients (76%) underwent ptosis surgery; frontalis sling was the most common procedure (34.4%).
- ADHD diagnosed in 156 patients (18.01%), compared with 5.6%-7.6% in the general pediatric population.
- Methylphenidate was the most frequently prescribed ADHD medication (64%).
- Factors significantly associated with higher ADHD risk (p < 0.05): male sex, ptosis diagnosis after age 1 year, eyelid patching for amblyopia, residual ptosis, history of ptosis surgery, and levator resection surgery specifically.
What it means for a patient
- Nearly 1 in 5 children with congenital ptosis in this study had ADHD, roughly two to three times the rate seen in children generally.
- Boys, children diagnosed with ptosis after age 1, those who needed eye patching for a lazy eye, those with ptosis that persisted after surgery, and those who had ptosis surgery (especially levator resection) had a higher ADHD risk.
- The authors recommend clinicians consider early ADHD screening in children with congenital ptosis, particularly those with these risk factors.
- This is a cross-sectional, retrospective study, so it identifies an association, not a proven cause.
Why this paper matters
It is described as the first national study to measure the ADHD rate in children with congenital ptosis, finding it nearly three times the general pediatric rate, and identifies specific risk factors.
Terms
- Congenital ptosis: a drooping upper eyelid present from birth, from a weak or underdeveloped levator muscle.
- ADHD (attention-deficit/hyperactivity disorder): a neurodevelopmental condition affecting attention, activity level and impulse control.
- Frontalis sling: a ptosis repair connecting the eyelid to the forehead muscle when the eyelid's own lifting muscle is very weak.
- Levator resection: a ptosis repair that shortens and tightens the eyelid-lifting muscle.
- Amblyopia: reduced vision in an eye from abnormal visual development in childhood, sometimes treated with patching.
- Cross-sectional study: a study that looks at data from a population at a single point in time, rather than following patients forward.