An unusual case of complete ptosis and failure of elevation due to severe facial trauma

A modified technique combining excision of the levator muscle and tarsus for blepharoptosis in Asians: a 6-year experience with 116 cases

BACKGROUND

In patients with blepharoptosis, the function of levator muscle is insufficient or completely absent, causing blepharoptosis in various degrees. For mild or moderate blepharoptosis, levator advancement or resection is commonly performed. However, in severe cases, undercorrection results and recurrence often occur even a great length of levator muscle is resected. Because the levator muscle makes the upper eyelid move in a physiologic direction, exerting the function of residual levator muscle is still a more preferred approach for correction of blepharoptosis. This study combined tarsus resection with levator resection. The resected tarsus can offset the amount of the levator excised, making this technique applicable for severe cases.

METHODS

This study included 116 patients (175 eyelids) with moderate or severe ptosis who underwent combined excision of the levator muscle and the tarsus. For cases of bilateral blepharoptosis with different levator functions between the two eyelids, surgery was performed for more severe side first and for the other side 6 months later. Postoperatively, the correction and symmetry results were evaluated and analyzed using chi-square testing by SPSS (version 10.0).

RESULTS

Adequate or normal correction was achieved in 149 eyelids (85.1%). The difference in correction results did not differ significantly between moderate and severe cases. With a two-stage operation, 98 patients (84.5%) obtained good or fair asymmetry results, and no statistically significant difference existed between the bilateral and unilateral cases.

CONCLUSION

The described technique appears to be effective for both moderate and severe ptosis, with better biomechanics and a satisfying aesthetic outcome.

A new non-incisional correction method for blepharoptosis

PURPOSE

The present report introduces our correction method for blepharoptosis, in which major incisions are made on neither the skin nor the conjunctiva of the upper eyelid, and no dissection of the eyelid tissues is required.

METHODS

After turning the upper eyelid inside out, threads are introduced into it through the conjunctiva close to the superior fornix. Then the superior palpebral levator muscle and the tarsus are connected using threads. This thread application is performed at two-to-four locations of the upper eyelid. By tightening the threads, the tarsus is elevated and the ptotic eyelid is corrected. A total of 624 eyelids in 390 patients with mild or moderate ptosis were operated on with this surgical method. Effectiveness of the treatment was evaluated referring to the degree of improvement. Furthermore, frequencies of complications were evaluated.

RESULTS

Among 416 eyelids with mild ptosis, complete correction of ptosis was achieved with 406 eyelids (97.5%). Among 208 eyelids with moderate ptosis, improvement was achieved with 185 eyelids (88.9%), with complete correction for 156 eyelids (75%).

CONCLUSION

Since the present method enables effective correction of the blepharoptosis with a simple technique, minimised recovery time and no scarring, it provides a useful surgical option for the treatment of mild and moderate blepharoptosis.