Advancement of Whitnall's ligament via the conjunctival approach for correction of congenital ptosis

Abstract

PURPOSE To conduct a preliminary study on ptotic eyelids with unilateral, congenital, simple partial ptosis, operated by advancement of Whitnall's ligament via the conjunctival route. METHOD A prospective, interventional, clinical study. RESULTS A total of 10 patients were recruited. The ptosis was 4 mm or less (range 2-4 mm; mean 2.7) and LPS action was greater than 5 mm (range 6-14 mm; mean 9.7). The ptosis was corrected by advancement of Whitnall's ligament by plication of the levator aponeurosis via the conjunctival route. Postoperatively, correction within 1 mm of the normal lid height was taken as good correction. All patients were assessed for a minimum of one year with regard to the amount of correction, residual ptosis, lid lag and lagophthalmos. In our study, good correction, i.e. within 1 mm of the normal fellow eye in primary gaze, was obtained in 80% of patients. Patients with more than or equal to 8 mm levator function gave better results. Undercorrection occurred in two patients. Lid lag and lagophthalmos occurred in all patients but was within acceptable limits. CONCLUSION Advancement of Whitnall's ligament by plication of the levator aponeurosis via the conjunctival route is a viable procedure, which has all the advantages of performing the same technique via the cutaneous approach, i.e. shorter surgical time, minimal dissection of tissue planes and reversibility. The conjunctival approach has the added advantage of being cosmetically more acceptable as there is no visible scar on the lid. The technique also offers satisfactory functional results with few (correctable) complications.