Clinical presentation and management of congenital ptosis

Figures & data

Figure 1 Upper eyelid interferes with the visual axis causing stimulus deprivation or induces amblyogenic astigmatism.

Table 1 Choice of surgical technique according to the grade of ptosis and levator function

Technique	Indication	Levator function	Complications
Fasanella–Servat	Mild congenital ptosis	>10 mm	Dermatochalasis, undercorrection, overcorrection, bleeding, wound dehiscence, corneal abrasion, skin crease level defect
Aponeurosis surgery	Mild ptosis	>10 mm	Asymmetric skin crease
Levator resection	Mild ptosis	>5 mm	Corneal exposure, entropion, contour abnormality, conjunctival prolapse
Frontalis sling	Amblyopia prevention Severe ptosis	<2 mm	Corneal exposure, infection, granulomas
Whitnall ligament sling	Mild–severe ptosis	>3 mm	High risk of reintervention
Muller resection	Mild ptosis	>10 mm	Corneal abrasion, undercorrection

Figure 2 Fox pentagon technique.

Notes: (A) Skin mark. (B) Wright’s fascial needle. (C) Control the eyelid shape. (D) Nylon tied together.

Figure 3 (A) Preoperative and (B) postoperative result of frontalis sling procedure in a case of severe ptosis.

Figure 4 Aponeurosis of the levator muscle.