Surgical options for congenital ptosis with poor levator muscle function.

Abstract

HE SURGICAL approach to the correcT tion of congenital ptosis is based on the amount of levator muscle function. It is generally agreed that levator resections, tucks, or advancements provide adequate correction for cases with fair (5 mm to 7 mm) or good (8 mm or more) levator muscle function. Children with poor (4 mm or less) or absent levator muscle function are particularly difficult to treat. Frontalis suspension procedures using various suspensory materials and sutures are advocated by many surgeons for the correction of severe congenital ptosis. More recently, alternative procedures such as maximal or “supermaximal” levator resection”* and Whitnall’s sling3 have been proposed to correct this problem. EVALUATION In a child with severe unilateral or bilateral congenital ptosis, the levator muscle function should be examined in both eyes. The eyelid excursion is assessed by having the child look up and down while the brow is being held firmly. A millimeter ruler is held vertically in front of the lids of one eye, and the amount of excursion from extreme down to the extreme up position is measured. The distance between the lid crease and the lid border and the width of the palpebral aperature in the primary position is measured and recorded for each eye. The normal lid has an excursion of 15 mm, whereas a ptotic lid usually moves from 4 mm to 12 mm. As previously stated, poor levator function is considered 4 mm or less. The patient should be