Tarsal buckle with conjunctival prolapse following levator plication for unilateral congenital ptosis

Abstract

An 8-year-old child underwent uneventful levator plication surgery for unilateral congenital ptosis. Postoperative course for initial few days was uneventful but on day 7, the patient was brought with conjunctival prolapse from the undersurface of upper eyelid due to tarsal kinking and eversion. Early medical management was initiated with frequent surface lubrication to avoid conjunctiva dryness. Under general anaesthesia, right-sided conjunctival repositioning was performed with an eyelid spatula supplemented by three forniceal stay sutures to retain the conjunctiva in its anatomical place. To reverse the tarsal kinking, continued downward traction suture was placed for a period of 2 weeks. At the end of 4 weeks, the conjunctival prolapse was completely resolved with a well-formed superior fornix. At the end of 3 months, the symmetric eyelid position was maintained without any additional complications.

Keywords: medical education; ophthalmology; plastic and reconstructive surgery.

Figure 1

(A) Following ptosis surgery at the end of 7 days conjunctival prolapse underneath the upper eyelid margin was evident. (B) Intraoperatively on day 10, the prolapsed conjunctiva increased in size. (C) After eversion of the lid margin there was horizontal tarsal kinking about 4–5 mm away from the lid margin. (D) After repositioning the conjunctiva and tarsal straightening, a pressure was applied on either side of the eyelid for few minutes. After that three forniceal sutures were placed to hold the conjunctiva in its anatomical place. An inverse eyelid traction suture was placed to counter the recurrence. At the end of 4 weeks, there was a complete regression of the conjunctival prolapse with symmetric eyelid position.