Experiences in treating congenital eyelid ptosis

Over the past 15 years, the authors have treated 65 cases of eyelid ptosis, involving 93 eyes. Of this number, 42 cases (59 eyes) were congenital manifestations, and 13 of these cases (26 eyes) presented blepharophimosis. Generally, the surgical treatment of congenital ptosis is based upon the preoperative state of the levator function. However, the authors have encountered severe lid lag in patients who had undergone a frontal suspension using the fascia lata, and since then, a percutaneous levator resection has become their treatment of choice. Based on the preoperative levator functioning, some guidelines have been reported with regard to the amount of the levator resection. When treating young children, however, an accurate assessment of the preoperative levator function is virtually impossible. Further, because the levator muscle is invariably pulled and elongated during the surgery, an accurate measurement of the levator resection that was decided upon preoperatively is not practical. Therefore, the authors use Berke's intraoperative decision approach, which entails resecting the levator muscle so that the resulting lid margin covers the upper 2 to 3 mm of the cornea. It should be kept in mind that a wide undermining of the conjunctiva may result in a postoperative relapse of the conjunctiva, and to pervent this, stitches are placed between the tunica conjunctiva and the supercilium to provide a bolster, thereby forming a deep fornix. Should the levator resection prove to be insufficient, the authors are prepared to add a frontal suspension. So far, however, no cases have required this additional suspension. The authors discuss representative cases.