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Alternative Technique to the Frontalis Fascial Sling for Blepharoptosis Repair

Ophthalmology, Indiana University, Indianapolis, IN

Commercial Relationships: M.H. Boyle, None; W.H. Nunery, None.

Support: None.

Abstract

Purpose:

Frontalis sling has been the most common method of repairing ptosis with poor levator function. Many variations of this procedure have been described. The most often described technique uses three stab incisions above the brow line, and several supraciliary incisions on the lid. This creates a geometric pattern of surgical scars, which is easily identifiable. It also fails to form a symmetric lid crease with good lid contour. We propose an alternative procedure, using a single stab incision above the brow line combined with a lid crease incision. Furthermore, we advocate the use of autogenous fascia over synthetic material. This approach has offered good cosmetic and function results in both congenital and acquired ptosis secondary to poor levator function.

Methods:

This is a retrospective chart review of sixteen patients (twenty–eight lids) who underwent a modified frontalis sling procedure (as described above), with WHN as the primary surgeon. Indications for this procedure included ptosis with poor levator function. Underlying etiologies for the ptosis included congenital (n=9), myasthenia gravis (n=2), third nerve palsy (n=3), and CPEO (n=2). Pre and post operative records were examined to determine the diagnosis, level of dysfunction, satisfaction with results, and presence of any complications. Seven of the patients had undergone previous attempts at ptosis repair. Age range was from 4 to 83 years, with an average of 42.0 years. Seven of the patients were pediatric.

Results:

Patient were followed anywhere from 2–18 months in the postoperative period. Average length of follow–up was 5.4 months. Satisfactory lid position was obtained on twenty–five of twenty–eight lids (89%). After surgery, seven patients complained of ocular surface irritation, with five eyes demonstrating superficial punctate keratopathy (18%). Three of these patients were controlled with lubrication alone, and two (7%) required surgical intervention to protect the cornea. Mild lagophthalmos (1–3mm) was seen in six lids (21%).

Conclusions:

Our modified version of the frontalis sling offers good functional results, and decreases the visibility and number of the surgical scars. It can be utilized successfully in both congenital and acquired ptosis with poor levator function, and should be considered an alternative to the traditional sling design.

Keywords: eyelid • clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical (human) or epidemiologic studies: outcomes/complications

© 2005, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any part of this abstract, contact the ARVO Office at arvo{at}arvo.org.