Abstract
Surgical techniques for ptosis repair continue to evolve as we gain a better understanding of the anatomy and physiology of the eyelid. External repair by levator advancement and internal repair by Muüller’s muscle-conjunctiva resection are the most established surgical techniques used for acquired ptosis today. Controversy over their relative indications, advantages, and disadvantages exist. The advent of new surgical techniques and modifications has further complicated traditional algorithms that guide a surgeon towards choosing an external vs. internal approach. Specifically, the use and interpretation of pre-operative phenylephrine testing has recently been challenged. The purpose of this study is to review the evolution of external and internal ptosis repair techniques, and current trends in pre-operative evaluation and surgical management of acquired ptosis.
Highlights
Blepharoptosis is one of the most commonly encountered eyelid disorders in ophthalmology
We focus on the two most favored techniques that have emerged for surgical repair of involutional ptosis: the external levator advancement and the internal, Müller’s muscle-conjunctiva resection (MMCR) and their modifications
The advancements in external and internal repair have added a myriad of techniques to the surgical armamentarium for correction of ptosis
Summary
Blepharoptosis is one of the most commonly encountered eyelid disorders in ophthalmology. The literature is replete with reports on advantages of different surgical techniques to treat similar etiologies[8,9,10]. This has led to further investigations on the anatomy of the levator muscle complex and Müller’s muscle in an attempt to better define their roles in eyelid elevation and guide surgical interventions[11,12]. We focus on the two most favored techniques that have emerged for surgical repair of involutional ptosis: the external levator advancement and the internal, Müller’s muscle-conjunctiva resection (MMCR) and their modifications
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