- Most authors choose to operate on the affected eyelid only in unilateral congenital ptosis. Bernadini et al. (2007) report an 85% success rate (defined as symmetry within 1 mm between eyelids in primary gaze).
- Bernardini et al. (2013) summarize their key points to successful treatment.
- Autologous fascia lata is the gold standard.
- Silicone rod might be preferred in acquired cases with poor Bells phenomenon.
- Tarsal fixation of graft material can increase success of frontalis suspension
- Visibility of central brow incision can be masked by leveling it with the peripheral incisions.
- Presence of preoperative spontaneous unilateral brow elevation correlates with excellent surgical outcomes in patients with unilateral congenital ptosis.
- Unilateral surgery should be preferred for simple unilateral poor levator function congenital ptosis.
- The downside in congenital ptosis is that there is no drive to lift the ptotic brow, and amblyopia remains a risk. There can also be undesirable asymmetry because the brow frontalis lift on the ptotic side cannot match the levator lift on the other side.
Figure 1. Fascia lata. Courtesy Rona Z. Silkiss, MD, FACS.
Figure 2. Fascia lata. Courtesy Rona Z. Silkiss, MD, FACS.
Figure 3. Fascia lata. Courtesy Rona Z. Silkiss, MD, FACS.
Figure 4. Fascia lata before. Courtesy Rona Z. Silkiss, MD, FACS.
Figure 5. Fascia lata after. Courtesy Rona Z. Silkiss, MD, FACS.
- There are times when excision of the normal levator and bilateral sling patient is indicated (Beard 1965). Cates and Tyers (2008) report on this approach for treating patients with congenital and jaw winking ptosis. Usually it is used in cases where the jaw-wink is very prominent.
- Others advocate bilateral sling placement without excision of the normal contralateral levator (Callahan 1972). This equalizes palpebral fissure in primary gaze, downgaze (lid lag), and lagophthalmos with eyelid closure or blink.