Correction Of Upper Eyelid Ptosis Research Articles

A New Diagnostic Method for Ptosis of the Upper Eyelid

Currently, surgical treatment of ptosis of the upper eyelid does not always lead to a good anatomical and physiological result — the frequency of dissatisfaction with the results of treatment is 8–26 %, and repeated operations on the muscle that lifts the upper eyelid are performed in 8.7–18 % cases. An important aspect of the successful treatment of upper eyelid ptosis is the preoperative examination of the patient; however, standard diagnostic methods do not provide complete information about the functional features of the upper eyelid levator. The purpose of the study is to improve the algorithm for preoperative examination of the upper eyelid in ptosis with the study of the contractility and fatigue of the upper eyelid levator. On the basis of the Helmholtz National Medical Research Center of Eye Diseases in the period from 2021 to 2022, 63 patients (67 eyes) aged from 5 to 78 years with different types of blepharoptosis admitted for surgical treatment were examined. We have developed a comprehensive dynamometric preoperative assessment of the upper eyelid levator with a study of the contractility and fatigue of this muscle using weights. For comparison and determination of normal parameters, the study was also carried out on paired intact eyes (59 eyes) and in 40 healthy people. Indicators of contractility and fatigue of the levator of the upper eyelid were obtained in normal conditions and with ptosis of the upper eyelid, and differences in these indicators were revealed in congenital and acquired blepharoptosis. With congenital ptosis of the upper eyelid, the contractility and fatigue of the levator of the upper eyelid is low, while with acquired ptosis (senile), the contractility is medium, and fatigue is medium or high. A gradation of the values of contractility and fatigue of the upper eyelid levator in blepharoptosis was developed, on the basis of it an algorithm for choosing a method for surgical correction of upper eyelid ptosis was proposed. The developed method of dynamometric preoperative study of the anatomical and functional features of the upper eyelid levator using weights is a simple and affordable method for objectively assessing the state of contractility and fatigue of the levator, which can improve the efficiency of surgical correction of upper eyelid ptosis.

Botulinum Toxin Treatment for Botulinum Toxin–Induced Blepharoptosis

Blepharoptosis, or eyelid ptosis, is one of the most common significant potential side effects of botulinum toxin (BTX) injection and is defined as drooping of the upper eyelid. Botulinum toxin injection to the pre-tarsal orbicularis oculi muscle for the correction of upper eyelid ptosis. We reviewed 2 patients with mild upper eyelid ptosis following BTX injection. The patients received pre-tarsal BTX injections via a transdermal approach. Signed consent was obtained from the patients for the publication of their case details and images. Ptosis was evaluated by measuring marginal reflex distance (MRD) values before and 2 weeks after treatment. The efficacy of the treatment was defined by improvement of more than 1 to 2 mm difference in MRD between the 2 eyes. The BTX injection is hypnotized to work by weakening the pre-tarsal orbicularis selectively, tending toward a balance of force favoring retraction. Botulinum toxin application to the pre-tarsal orbicularis was effective in raising the upper eyelid ptosis induced by BTX injection.

Frontalis–Orbicularis Muscle Advancement for Correction of Upper Eyelid Ptosis: A Systematic Literature Review

To review the level of standardization of frontalis-orbicularis muscle advancement to correct severe blepharoptosis and the degree of scientific evidence supporting the procedure as a useful modality of blepharoptosis repair. The authors searched the Medline, Lilacs, and Scopus databases for all articles in English, Spanish, and French that used as keywords the terms "frontalis muscle flap," "orbicularis muscle flap," and "ptosis." Data retrieved included authorship specialty, geographic region where the surgeries were performed, characteristics of the samples reported, type and dimensions of the flaps used, time of follow-up, rate of undercorrection, and complications. Thirty-eight articles were retrieved and analyzed. Most studies originated from Asian countries, especially China, Taiwan, and Korea. Many variations of the procedure were encountered, including location of incisions and frontalis flap design. There were 23 case series with more than 10 patients. None compared the procedure to conventional frontalis suspension surgery. The samples were not homogeneous, including patients with different type of ptosis, variable degrees of levator function, and using distinct methods of evaluating eyelid position. Undercorrection rates ranged from 1.8% to 38% with a median value of 12.2%. The rate of complications (eyelid crease abnormalities, entropion, hematoma, and supraorbital nerve injury) was low. The direct frontalis-orbicularis muscle advancement has been judged positively in all reports analyzed. However, the level of standardization of the surgery is low, and the reported series are not homogeneous. Further studies are needed to better evaluate this operation.

Mueller's Muscle Conjunctival Resection With Skin-Only Blepharoplasty: Effects on Eyelid and Eyebrow Position.

To determine the effect of concurrent blepharoplasty and Mueller's muscle conjunctival resection (MMCR) surgery on eyelid position and eyebrow height. Clinical data from 274 eyes that met inclusion criteria for this study were reviewed. Mueller's muscle conjunctival resection surgery was performed alone in 198 eyes and was performed with concurrent blepharoplasty in 76 cases. In this study blepharoplasty consisted of only skin removal, leaving the muscle, fat, and tarsus intact. Preoperative and postoperative pupil to eyebrow, and eyelid margin to eyebrow distances were calculated and compared. Preoperative margin reflex distance 1 (MRD1) was similar for both groups of patients (p > 0.05) as was the postoperative MRD1 (p > 0.05). The change in MRD1 was similar between patients undergoing MMCR alone versus those undergoing MMCR with blepharoplasty (1.5 mm vs. 1.3 mm, respectively, p = 0.36). For similar amounts of tissue resection, the postoperative change in MRD1 was similar for patients undergoing MMCR-only surgery and MMCR with blepharoplasty (p > 0.05). Eyebrow height significantly decreased following both MMCR with blepharoplasty (0.73 mm, p < 0.05) and MMCR-only surgery (0.87 mm, p < 0.05), and this change in eyebrow height was not significantly different between the 2 groups. Combining MMCR surgery with skin-only blepharoplasty does not significantly alter eyelid height when compared with MMCR surgery alone for the correction of upper eyelid ptosis. This may assist in preoperative planning for combined MMCR with skin-only blepharoplasty.

Surgical approach to the superior mid-orbit

Access to the superior mid-orbit is required for procedures on the levator muscle in the correction of upper eyelid ptosis and in surgery aimed at local lesions in this region. The purpose with this human cadaver study was to clarify the anatomical substrate for a surgical approach to the levator muscle and the upper mid-orbit structures, in which the orbital septum and the retroseptal fat pad is not harmed during surgery. Macro-anatomical dissections and histological examinations were performed on five human orbits from three formalin embalmed cadaver heads. It was found that the orbital septum extends posteriorly from its junction with the levator aponeurosis. This posterior continuation of the orbital septum encloses the superior orbital fat pad and separates this from the anterior surface of the levator muscle. In between the orbital septum and the levator, there is a dissection space that provides a minimal invasive access corridor to the structures in the upper mid-orbit.

Muller’s Muscle Resection for Ptosis and Relationship with Levator and Muller’s Muscle Function

Purpose: Results of Muller’s muscle resection in patients with ptosis and its relationship with levator and Muller’s muscle function.Methods: Prospective review of medical records of all pateints who underwent open sky Mullerectomy for correction of upper eyelid ptosis. The study period was from January 2008 to July 2009. Levator function, MRD1, Phenylepherine test result and extent of ptosis correction were recorded. Excised muscle tissue in few cases were subjected to histopathology.Results: In 11 patients who underwent 13 mullerectomy procedures for correction of upper eyelid ptosis, MRD1 increased an average by 2.54mm. The amount of ptosis correction was 4.28mm in pateints with either good levator function and/or Muller's action and 1mm in patients where both responses to phenylepherine and levator functions were poor. Histopathology revealed both straited and smooth muscle tissue in the excised specimens in all cases.Conclusion: Mullerectomy porbably involves plication of the posterior layer of the levator aponeurosis. Results of Muller's muscle resection is good in patients with good levator function and/or good Mullers action and poor if both Muller and levator function are poor.

Müller's Muscle–Conjunctival Resection for Correction of Upper Eyelid Ptosis

To evaluate the outcome of Müller's muscle-conjunctival resection (MMCR) for correction of upper eyelid ptosis and to explore the relationship between phenylephrine testing, muscle resection, and surgical outcome. Medical records were reviewed for all patients who underwent MMCR at the Jules Stein Eye Institute, Los Angeles, California, from January 1, 1999, through June 30, 2005. Outcome measures were margin reflex distance-1, ptosis correction after instillation of phenylephrine drops, extent of MMCR, ptosis correction, and eyelid symmetry. In 80 patients who underwent 131 MMCR procedures for correction of upper eyelid ptosis, margin reflex distance-1 increased on average by 1.6 mm (P < .001). In 106 patients (81%), eyelid symmetry equal to or less than 1 mm was achieved (P = .02). Phenylephrine testing underestimated the extent of ptosis correction achieved with MMCR. A weak correlation was found between the extent of MMCR and ptosis correction (r = 0.2; P = .04). Müller's muscle-conjunctival resection is effective for ptosis correction in patients with good levator muscle function; good eyelid symmetry is achieved in most patients. Phenylephrine testing underestimated the ptosis correction achieved with MMCR by 40%. The relationship between MMCR and ptosis correction is complex.

Frontalis Suspension for Upper Eyelid Ptosis: Evaluation of Different Surgical Designs and Suture Material

To compare two sling designs (single loop or double pentagon) and a variety of suture material that was used in frontalis suspension surgery for correction of upper eyelid ptosis. Retrospective, nonrandomized, comparative interventional case series. Medical record review of 99 patients (164 surgeries) who underwent frontalis suspension surgery for upper eyelid ptosis was conducted at the Jules Stein Eye Institute in 1996 to 2002. Functional and cosmetic success, margin reflex distance (MRD) and lagophthalmos were evaluated. MRD increased an average of 1.1 mm after the operation (P < .001). Ptosis recurrence was noticed in 42 cases (26%); polytetrafluoroethylene achieved the lowest recurrence rate (15%), although not statistically significant. No difference in functional success, ptosis recurrence, or change in MRD was noticed between single loop and double pentagon design. A better cosmetic outcome was noted in cases in which nylon suture was used. Complications included four cases (2.4%) of over-correction, three cases (1.8%) of suture infection (all in polytetrafluoroethylene), two cases of pyogenic granuloma (1.2%), and two cases (1.2%) of suture exposure. Frontalis suspension for upper eyelid ptosis resulted in 26% ptosis recurrence after a mean of 12 months from first surgery. Polytetrafluoroethylene showed the lowest incidence of ptosis recurrence. No statistically significant difference was found between different suture materials or loop shape that was used in the surgical technique. A better cosmetic outcome, as graded by different observers, was noted in cases in which a nylon sling was used.

A simple approach to identification of the levator aponeurosis in the correction of eyelid ptosis.

A new method of approach for the correction of upper eyelid ptosis is described. This involves both conjunctival and skin incisions. It allows for greater ease of identification of the levator aponeurosis and appears to facilitate in the identification of Müller's muscle. Although advised for all patients requiring ptosis correction, it is particularly recommended in those patients in whom the eyelids are involved with extensive posttraumatic scarring.

Correction of lower eyelid ptosis in the anophthalmic orbit: a long-term follow-up.

We describe a 10-year review of 53 patients having had correction of lower eyelid ptosis using fascia lata sling suspension by the operation first described in 1973. The overall conclusion is that this continues to be a reliable procedure with a low complication rate. Four major changes relating to operative technique that create a better result are as follows: (1) the surgical correction must begin with a prosthesis that is ideal for the socket; (2) the fascial strip is narrower at 2 mm; (3) the lateral orbital rim burr hole is placed higher; and (4) the passage of the fascial strip is facilitated by the use of Wright's needle. The optimal sequence of operative procedures in the anophthalmic orbit syndrome is (1) correction of enophthalmos and superior sulcus depression, (2) correction of lower eyelid ptosis, and (3) correction of upper eyelid ptosis.