Surgical treatment of unilateral severe simple congenital ptosis

Abstract

Unilateral congenital ptosis with poor levator function of ≤4 mm continues to be a difficult challenge for the oculoplastic surgeon. Surgical correction can be accomplished with unilateral frontalis suspension, maximal levator resection, or bilateral frontalis suspension with or without levator muscle excision of the normal eyelid. Bilateral frontalis suspension was proposed by Beard and Callahan to overcome the challenge of postoperative asymmetry, allowing symmetrical lagophthalmos on downgaze, postoperatively. However, most surgeons and patients prefer unilateral correction on the abnormal eyelid either with a frontalis suspension or maximal levator resection. Frontalis suspension may be performed through the various surgical techniques using different autogenous or exogenous materials. Autogenous fascia lata is considered the material of choice with low recurrence rates but carries the drawbacks of the difficulty of harvesting and postoperative morbidity from the second surgical site. Recent reports have suggested that maximal levator resection provides improved cosmesis, a more natural contour, and avoids brow scars. Although both treatments have shown to have similar success rates, there is much debate about what the most favorable method for treating severe unilateral ptosis. We review the literature on the various surgical treatments for unilateral severe congenital ptosis, including the rationale, advantages and disadvantages of each technique.

Maximal levator resection versus Gore-Tex® sling for congenital blepharoptosis with poor levator function

“…Other surgeons have embraced MLR, to avoid sling-related complications and achieve better outcomes in unilateral and amblyopic cases, in which a compensatory frontalis action might be absent. [ 6 ]…”

“…We found that the downward slide of lashes could be avoided by excising a segment of skin and orbicularis above the crease then suturing both incision lips (more importantly the pretarsal flap) to the resected LPS at the end of the procedure, or to the tarsal plate instead. [ 6 ] Twelve of the MLR treated eyes had this additional step, with no postoperative lash ptosis recorded ( P = 0.092).…”

Outcomes of Maximum Levator Resection in Severe Upper Eyelid Ptosis at a Tertiary Oculoplastic Service

“…Severe congenital ptosis with poor levator function of ≤ 4 mm is not easy for the oculoplastic surgeon to deal with. 5 The type of Surgery for the correction of congenital ptosis is based on surgeon's choice which may be frontalis suspension (FS) or MLR, Different studies are available which support both types. 6 In both choices, the surgery is a challenge because of cosmetic and physiological implications.…”