A guide for determining center of levator aponeurosis and palpebral fissure width in blepharoptosis surgery

Abstract

Formation of a natural upper eyelid curvature and elevation of the upper eyelid have to be accomplished in blepharoptosis surgery. We describe an easy and reproducible method to obtain a natural eyelid curvature. First, the mechanical center of the levator aponeurosis, representing the point where the surgeon can feel equal resistances from the medial and lateral sides of the aponeurosis, was determined. Then, the supra-pupillary point on eye opening, namely the center of the palpebral fissure, was secured by pulling the eyelid margin. When correctly pulled, the eyelid margin formed an isosceles triangle. The center of the levator aponeurosis was then fixed on the tarsus corresponding to the supra-pupillary point on eye opening. After determining the apex of the upper eyelid, additional sutures were made to obtain a quadratic curve of the upper eyelid, resulting in a natural eyelid curvature.