Current techniques in surgical correction of congenital ptosis

Abstract

Ptosis refers to vertical narrowing of the palpebral fissure secondary to drooping of the upper eyelid to a lower than normal position. Ptosis is considered congenital if present at birth or if it is diagnosed within the first year of life. Correction of congenital ptosis is one of the most difficult challenges ophthalmologists face. Multiple surgical procedures are available including, frontalis sling, levator advancement, Whitnall sling, frontalis muscle flap, and Mullerectomy. Selection of one technique over another depends on the consideration of several factors including the surgeon experience, the degree of ptosis in the patient, as well as the degree of levator muscle function. Current recommendations for the correction of congential ptosis vary based on clinical presentation. Advantages and disadvantages of each of these procedures are presented with recommendations to avoid complications.

Frontalis Muscle Flap Suspension for the Correction of Congenital Blepharoptosis in Early Age Children

“…There are many methods for the surgical correction of blepharoptosis, and 2 commonly used are levator palpebrae superioris shortening and frontalis muscle flap (or frontalis muscle myofascial flap) suspension [1], [3], [6]. Each method has its corresponding advantages, disadvantages, complications, and indications.…”

“…Each method has its corresponding advantages, disadvantages, complications, and indications. Levator palpebrae superioris shortening is appropriate for mild to moderate blepharoptosis when the muscle strength of the levator palpebrae superioris >5 mm [1], [3], [6]. For moderate to severe cases when the muscle strength of the levator palpebrae superioris <4 mm, frontalis muscle flap (or frontalis muscle myofascial flap) suspension surgery is appropriate [1], [3], [6].…”

“…Regardless of age, surgical correction of congenital blepharoptosis in children is challenging as the tissue of the eyelids and surrounding area is vulnerable, coping with surgery is hard, and it is difficult to position the eyes under general anesthesia [3]. Many techniques for the correction of congenital blepharoptosis using autologous fascia lata and permanent suture material have been described, and the choice of technique depends on many factors including the age of the patient and the severity of ptosis [1], [3], [6], [7].…”

“…Many techniques for the correction of congenital blepharoptosis using autologous fascia lata and permanent suture material have been described, and the choice of technique depends on many factors including the age of the patient and the severity of ptosis [1], [3], [6], [7]. The most commonly used technique is frontalis muscle suspension, and various modifications have been described [4], [8]–[12].…”

Oculoplastics and pediatric ophthalmology: An update

“…In this issue, Allard and Durairaj,5 from Colorado, review the current treatment procedures and the management of congenital ptosis. They divide congenital ptosis either as an isolated finding or as a component of many congenital syndromes.…”