TOPLINE

A new study of more than 850 children found that those born with a drooping eyelid (congenital ptosis) were almost three times more likely to have attention-deficit/hyperactivity disorder (ADHD) than kids in the general population (18% vs 5.6%-7.6%). The risk was higher among boys, children diagnosed with ptosis after age 1, those who underwent ptosis surgery, children with residual eyelid drooping after surgery, and those treated with eye patching for lazy eye.

METHODOLOGY

• In this retrospective study, researchers analyzed medical records of pediatric patients (aged 0-18 years) with congenital ptosis to investigate the condition's association with ADHD.
• The cohort included 866 children (485 boys; mean age at diagnosis, 3.66 years) who received a diagnosis of congenital ptosis at 12 Israeli hospitals between January 2010 and January 2023; in patients with ptosis in both eyes, only the right eye was included in the analysis.
• Children with less than 3 years of follow-up or incomplete records were excluded.
• The diagnoses of ADHD were made by neurologists using standard, internationally recognized clinical criteria.
• The data collected included each child's age and sex, general medical and ocular history, the age when ptosis was first diagnosed, which eye was affected, specifics of any eyelid surgeries performed (type and number), and details of ADHD diagnosis (including age at diagnosis and the medications prescribed).

TAKEAWAY

• Most children (76%) underwent ptosis surgery, with the frontalis sling being the most commonly used procedure.
• About 18% of children with congenital ptosis were diagnosed with ADHD, notably exceeding the 5.6%-7.6% prevalence in the general pediatric population.
• The risk for ADHD was 21% lower in girls than in boys and 15% higher in children who underwent eye patching for lazy eye than in those who did not (P < .05 for both). The risk was also 32% higher in children diagnosed with ptosis after age 1, 43% higher in those with lingering eyelid drooping after surgery, and 28% higher in those who had any ptosis surgery (all P < .05).
• When researchers excluded children with other eye conditions, the rate of ADHD diagnosis among those with congenital ptosis alone remained elevated at 12%, suggesting that the higher prevalence was not solely due to other eye problems but could be linked to congenital ptosis itself.

IN PRACTICE

"Paediatric ophthalmologists, oculoplastic surgeons, paediatric neurologists, and psychologists should collaborate to ensure timely congenital ptosis correction while monitoring for signs of ADHD," the researchers reported.

"Specific screening protocols should be implemented, particularly for high-risk groups identified in this study, with consideration for more frequent neurodevelopmental assessments during the first few years following congenital ptosis diagnosis or surgery," they added.

SOURCE

The study was led by Ofira Zloto of The Goldschleger Eye Institute at Sheba Medical Center in Ramat Gan, Israel. It was published online on September 15 in the British Journal of Ophthalmology.

LIMITATIONS

The study showed a link between ptosis and ADHD but could not prove that one caused the other. Relying on medical records to identify ADHD cases may have missed children with milder symptoms or those who were never formally diagnosed. Also, the study did not include data on ptosis severity.

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.