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Review
. 2017 Feb;31(1):58-64.
doi: 10.1055/s-0037-1598631.

Pediatric Blepharoptosis

Kevin T Jubbal  1 , Katarzyna Kania  1 , Tara L Braun  1 , William R Katowitz  2 , Douglas P Marx  1
Affiliations
Review

Pediatric Blepharoptosis

Kevin T Jubbal et al. Semin Plast Surg. 2017 Feb.

Abstract

Congenital blepharoptosis, caused by levator muscle dysgenesis, presents at birth and may lead to disturbed visual development and function. Other causes of ptosis in pediatric patients can be myogenic, neurogenic, mechanical, or traumatic. Timely correction is, therefore, critical, and careful preoperative planning and intraoperative considerations are crucial to achieve optimal outcomes and minimize potential complications. The various surgical techniques, including the frontalis suspension or sling, levator resection and advancement, Müller's muscle conjunctival resection (the Putterman procedure), and modified Fasanella-Servat procedure are each associated with distinct indications, benefits, and drawbacks, necessitating a unique tailored approach to each surgical candidate.

Keywords: blepharoptosis; droopy eyelid; pediatric ptosis.

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Figures

Fig. 1
Fig. 1
(A) Silicone sling surgery. The sling is staged to a needle that is passed in the pretarsal/suborbicularis plane. (B) Rhomboid configuration. The sling is passed to the brow via two brow incisions. The silicone rod is passed through a silicone sleeve and the eyelid is elevated to the desired intraoperative height. (C) Pre- and postoperative photo of a patient with left congenital ptosis treated with a frontalis silicone sling.
Fig. 2
Fig. 2
Autogenous fascia lata sling ptosis repair. (A) Harvesting fascia lata from the lateral leg. A fascia lata stripper is used. (B) The desired eyelid height is set by tightening the fascia lata strips.
Fig. 3
Fig. 3
Pre- and postoperative autogenous fascia lata sling ptosis repair. (A) Patient with isolated right congenital ptosis. (B) Postoperative photo taken 6 months after surgery. Note the left upper eyelid is now lower as compared in (A). This is due to Hering's law.
Fig. 4
Fig. 4
Anterior levator resection. (A) Intraoperative photo showing the levator aponeurosis that is being sutured to the tarsus with three 5–0 Vicryl sutures. (B) Preoperative photo of a patient with a right Marcus Gunn jaw wink and ptosis. (C) Postoperative photo taken 1 year after an anterior levator resection. The levator muscle was not extirpated and the wink remains, but is much less noticeable with the eyelid in a better position.
Fig. 5
Fig. 5
Modified Fasanella-Servat procedure. (A) The eyelid is everted; the tarsus, the conjunctiva, and the Müller's muscle are clamped. (B) After resecting the clamped tissue (not pictured), the Müller's muscle is sutured in a vertical mattress fashion to the tarsus with a 5–0 Nylon suture. (C) The suture is anteriorized to the eyelid skin and tied, which is removed 7 days later in the office. (D) Pre- and postoperative 2.5% phenylephrine testing in the office, and a 1-year postoperative right modified Fasanella-Servat procedure. Note the final eyelid height is well approximated by the phenylephrine test in (B).
See this image and copyright information in PMC

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