Association between congenital ptosis and ADHD: a national, cross-sectional study

Aim To examine the association between congenital ptosis and ADHD. Methods This is a retrospective, national, cross-sectional study. The diagnosis of blepharoptosis was confirmed by an ophthalmologist, while cognitive assessments and attention-deficit/hyperactivity disorder (ADHD) diagnoses were conducted by a neurologist using standardised clinical criteria. The study collected demographic data, ocular and systemic medical history, ptosis characteristics, surgical details, ADHD diagnoses and ADHD medication use. Results A total of 866 patients (485 males, 381 females) were diagnosed with congenital ptosis, with a mean age at diagnosis of 3.66 years. Among them, 673 patients (76%) underwent ptosis surgery, with frontalis sling being the most common procedure (34.4%). ADHD was diagnosed in 156 patients (18.01% compared with 5.6%–7.6% in the general paediatric population), and methylphenidate was the most frequently prescribed medication (64%). Several factors were significantly associated with an increased risk of ADHD, including male sex, a diagnosis of ptosis after the age of 1 year, undergoing eyelid patching for amblyopia, the presence of residual ptosis, a history of ptosis surgery and undergoing levator resection surgery (p<0.05). Conclusions This national cross-sectional study is the first to investigate the association between congenital ptosis and ADHD, revealing that nearly 20% of patients with congenital ptosis developed ADHD significantly exceeding that of the general paediatric population. Based on these findings, clinicians should consider early ADHD screening in children with congenital ptosis, especially in those presenting with risk factors allowing for timely intervention and appropriate treatment.