 Bilateral congenital ptosis |
 Result after transcutaneous bilateral levator resection |
 Pre operative |
 Post operative |
 Pre operative |
 Post operative |
Terminology
Ptosis is the drop of upper eyelid secondary to a levator deficiency.
Ptosis may be classified in two categories :
-congenital ptosis which are usually due to a dystrophy of the levator muscle.
-acquired ptosis which include aponeurotic defect, nerve palsies ( third nerve or sympathetic nerve ), myogenic or mechanical causes.
|
Bilateral congenital ptosis |
Result after transcutaneous bilateral levator resection |
|
Pre operative |
Post operative |
|
Pre operative |
Post operative |
Preoperative evaluation should include the following measures :
-amount of ptosis measured in millimeters
-levator function given by upper lid excursion measured in millimeters
-height of the skin crease.
Examination is completed by evaluation of Bell's phenomenon, hypotropia, jaw winking, pupillary abnormalities.
Treatment
Treatment of congenital ptosis depends on the levator function :
-when levator function is more than 4 mm., a levator resection is possible, utilizing an anterior or posterior approach. The amount of levator resection depends on the degree of ptosis and levator function. The reformation of the skin crease is associated with the skin closure.
-when levator function is less than 4 mm., brow suspension may be performed. Frontalis sling procedures are usually employed with autogenous fascia lata. The fascia latais commonly obtained with a fascial stripper via an incision in the thigh above the knee joint. The obtained fascial strip should be 12 cm. long and 1 cm. wide. The strip is then split into four strips about 2 mm. wide.
Foreign material such as silicone rod or PTFE may also be used as frontalis sling material, when obtention of fascia lata is not possible.
 Left congenital ptosis |
 Levator resection via transcutaneous approach |
 Preoperative |
 Postoperative |
 Preoperative |
 Postoperative |
Acquired ptosis is commonly associated with good levator function (more than 8 mm) : the choice of surgical procedure depends mainly on the degree of ptosis :
-aponeurosis advancement performed via anterior or posterior approach may be indicated for a moderate or severe acquired ptosis ( more than 2 mm.).
-excision of Muller's muscle with conjunctiva via a transconjunctival approach may be useful for a mild ptosis ( 2 mm. or less than 2 mm.).
 Involutional ptosis, orbital fat prolapse and dermatochalasis |
 Result after transcutaneous aponeurosis advancement combined with upper lid blepharoplasty |
