Monocular elevation deficiency associated ptosis misdiagnosed as simple congenital ptosis: management with Müller Muscle-Conjunctival Resection.
Emirhan Ozkul, Mehmet Serhat Mangan
✦ AI-curated · Sources linked
Case in brief
A 14-year-old girl referred with presumed congenital ptosis was found on ophthalmic examination to have marked right-eye elevation restriction in all gaze positions and mild hypotropia, consistent with monocular elevation deficiency (MED). Right margin-reflex distance was 1.5 mm versus 4 mm on the left; phenylephrine increased it to 2.5 mm. Because strabismus surgery was declined and poor Bell’s phenomenon raised concern about exposure, a 9-mm Müller muscle–conjunctival resection (MMCR) was performed. Eyelid height and contour were satisfactory and symmetrical at one month, without lagophthalmos or corneal complications; results remained stable at six months and one year.
What made this case unusual
Ptosis associated with MED had initially been mistaken for isolated congenital ptosis. The report describes successful use of MMCR in a pediatric MED case, with stable eyelid symmetry and no exposure complications despite poor Bell’s phenomenon.
Diagnostic / clinical pearl
In a patient presenting with ptosis, assess ocular motility: elevation restriction and hypotropia may indicate MED rather than isolated congenital ptosis and can affect surgical planning.
Why it matters
When strabismus surgery is deferred, this case suggests MMCR may be considered in selected patients with MED-associated ptosis and concern about exposure from more extensive ptosis procedures.