Ptosis of the anophthalmic socket results from superotemporal migration of sphere implants, cicatricial tissue in the upper fornix, or damage to the levator muscle or nerve (Fig 8-12). Small amounts of ptosis may be managed by prosthesis modification. Greater amounts require advancement of the levator aponeurosis. This procedure is best done under local anesthesia with intraoperative adjustment of eyelid height and contour, because mechanical forces may cause the surgeon to underestimate true levator function. Ptosis surgery usually improves a deep sulcus by bringing the preaponeurotic fat forward. Mild ptosis may be corrected with Müller muscle–conjunctival resection; however, this may shorten the superior fornix. Frontalis suspension is usually a less useful procedure because there is no visual drive to stimulate contracture of the frontalis muscle to elevate the eyelid.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.