Blepharoptosis: Evaluation, Techniques, and Complications

ABSTRACT

Blepharoptosis (ptosis) is one of the most common eyelid disorders encountered in ophthalmology. A detailed history and exam are crucial in the evaluation of a patient presenting with ptosis. This provides the correct guidelines for surgical planning. The appropriate surgical technique is usually determined by the degree of ptosis and levator function. The surgeon should have an armamentarium of several different techniques for the management of ptosis. This article will detail a modified approach to the traditional tarsomyectomy (Fasenalla-Servat procedure) and also discuss the levator advancement. Despite the proper preoperative evaluation and meticulous attention to technique, the ptosis surgeon may still encounter postoperative complications. The ability to manage the array of possible complications truly distinguishes the ptosis surgeon.

Ptosis - blepharoptosis - levator advancement - Fasenalla-Servat procedure - tarsomyectomy - frontalis suspension

REFERENCES

• 1 Arthurs B P, Della Rocca R C. Entropian. In: Della Rocca RC, Bedrossian EH Jr, Arthurs BP Ophthalmic Plastic Surgery: Decision Making and Techniques. New York; McGraw-Hill 2002: 77-89
• 2 Frueh B R. The mechanistic classification of ptosis.  Ophthalmology. 1980;  87 1019-1021
• 3 Dortzbach R K, McGerick J J. Diagnosis and treatment of acquired ptosis. In: Focal Points 1984 Clinical Modules for Ophthalmologists. American Academy of Ophthalmology Module 10 pp 2-9
• 4 Kearns T P. External ophthalmoplegia, pigmentary degeneration of the retina, and cardiomyopathy: a newly recognized syndrome.  Trans Am Ophthalmol Soc. 1965;  63 559-625
• 5 Lessell S, Coppeto J, Samet S. Ophthalmoplegia in myotonic dystrophy.  Am J Ophthalmol. 1971;  71 1231-1235
• 6 Eyelid Malpositions and Involutional Changes .In: Basic and Clinical Science Course Sec 7. American Academy of Ophthalmology pp 189-203
• 7 Meyer D R, Linberg J V, Wobig J L, McCormick S A. Anatomy of the orbital septum and associated eyelid connective tissues.  Ophthal Plast Reconstr Surg. 1991;  7 104-113
• 8 Gausas R E. Technique for combined blepharoplasty and ptosis correction.  Facial Plast Surg. 1999;  15 193-201
• 9 Putterman A M, Urist M J. Surgical anatomy of the orbital septum.  Ann Ophthalmol. 1974;  6 290-294
• 10 Lemke B N. Anatomy of the ocular adnexa and orbit. In: Smith BC, Della Rocca RC, Lisman RD, Nesi FA Ophthalmic Plastic and Reconstructive Surgery. Vol 1. St. Louis, MO; CV Mosby 1987: 3-74
• 11 Stasior G O, Lemke B N, Wallow I H, Dortzbach R K. Levator aponeurosis elastic fiber network.  Ophthal Plast Reconstr Surg. 1993;  9 1-10
• 12 Ertas F S, Ertas N M, Gulec S et al.. Unrecognized side effect of statin treatment: unilateral blepharoptosis.  Ophthal Plast Reconstr Surg. 2006;  22 222-224
• 13 Gay A J, Salmon M L, Windsor C E. Hering's law, the levators, and their relationship in disease states.  Arch Ophthalmol. 1967;  77 157-160
• 14 Fox S A. Modified Fasanella-Servat procedure for ptosis.  Arch Ophthalmol. 1975;  93 639-640
• 15 Putterman A M, Urist M J. Upper eyelid retraction after glaucoma filtering procedures.  Ann Ophthalmol. 1975;  7 263-266
• 16 Putterman A M, Fett D R. Muller's muscle in the treatment of upper eyelid ptosis: a ten-year study.  Ophthalmic Surg. 1986;  17 354-360
• 17 Berlin A J, Vestal K P. Levator aponeurosis surgery: a retrospective review.  Ophthalmology. 1989;  96 1033-1036
• 18 Crawford J S. Repair of ptosis using frontalis muscle and fascia lata: a 20-year review.  Ophthalmic Surg. 1977;  8 31-40
• 19 Leone Jr C R, Shore J W, Van Gemert J V. Silicone rod frontalis sling for the correction of blepharoptosis.  Ophthalmic Surg. 1981;  12 881-887
• 20 Carroll R P. Preventable problems following the Fasanella-Servat procedure.  Ophthalmic Surg. 1980;  11 44-51
• 21 Dortzbach R K. Ophthalmic Plastic Surgery: Prevention and Management of Complications. New York; Raven Press 1994: 65-90