方法：回顾性研究。收集2011-09/2021-02我院收治的轻中度先天性上睑下垂合并共同性外斜视(CPE)患者18例，轻中度单纯先天性上睑下垂(CP)患者19例和单纯共同性外斜视(CE)患者30例。比较三组患者屈光不正的患病率、弱视率、球镜度、散光度、等效球镜及眼轴长度。

结果：CPE组发生上睑下垂双眼发病共17例(94%)，而CP组单眼发病共13例(69%)，两组患者单双眼发病有显著差异(χ²=15.531，P<0.001)。三组间屈光参差及近视患病率差异有统计学意义(χ²_屈光参差=8.732，P_屈光参差=0.013； χ²_近视=6.047，P_近视=0.049)。CPE组屈光参差(χ²=8.072，P=0.004)及近视(χ²=4.555，P=0.033)患病率高于CP组，而CPE组与CE组之间屈光参差(χ²=0.559，P=0.454)及近视(χ²=0.055，P=0.815)患病率差异无统计学意义。CPE组球镜度(χ²=-31.143，P=0.002)、散光度(χ²=-23.434，P=0.028)、等效球镜度(χ²=-30.137，P=0.003)较CP组更偏向近视，眼轴(χ²=26.289，P=0.012)长于CP组，而与CE组无显著差异。儿童患者中CPE组的球镜较CE组更偏向近视(χ²=-16.831，P=0.016)，等效球镜较CP组更偏向近视(χ²=-18.391，P=0.020)。

结论：轻中度先天性上睑下垂合并共同性外斜视可加剧轴性近视、近视性散光和屈光参差的发生发展，较单纯上睑下垂更为严重。故早期行全面眼科评估并及时手术治疗可能有助于防治CPE对视力造成的损害。

METHODS:In this prospective observational study, we divided all patients between September 2011 and February 2021 into three groups: 18 patients with mild to moderate congenital ptosis coexisting concomitant exotropia(CPE), 19 patients with mild to moderate simple congenital ptosis(CP)and 30 patients with simple concomitant exotropia(CE). All subjects underwent ocular examinations, including axial length, and cycloplegic refraction. The prevalence of refractive errors, amblyopia, spherical power, astigmatism, spherical equivalent, and axial length were compared between CPE, CP and CE.

RESULTS:Ptosis occurred mostly in both eyes in CPE group about 17 cases(94%), but mostly in one eye in CP group about 13 cases(69%), with a significant difference between the two groups(χ²=15.531, P<0.001). There were significant differences in the prevalence of anisometropia(χ²=8.732, P=0.013)and myopia(χ²=6.047, P=0.049)among the three groups. The prevalence of anisometropia(χ²=8.072, P=0.004)and myopia(χ²=4.555, P=0.033)was higher in CPE than CP, while there was no significant difference in the prevalence of anisometropia(χ²=0.559, P=0.454)and myopia(χ²=0.055, P=0.815)between the CPE and CE. The spherical power(χ²=-31.143, P=0.002), myopic astigmatism(χ²=-23.434, P=0.028)and spherical equivalent(χ²=-30.137, P=0.003)of CPE were a higher refractive error and axial length(χ²=26.289, P=0.012)was longer than those in the CP, but there was no significant difference with the CE. In young group, the spherical power of the CPE was a higher refractive error than that of CE(χ²=-16.831, P=0.016), and the spherical equivalent of the CPE was a higher refractive error than that of CP(χ²=-18.391, P=0.020).

CONCLUSION:Mild to moderate congenital ptosis coexisting concomitant exotropia exacerbates the development of axial myopia, myopic astigmatism, and anisometropia, which is more severe than sample ptosis. Therefore, early ophthalmic evaluation and timely surgical treatment may prevent the visual acuity of damage caused by CPE.