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Anterior tarsectomy reoperation for upper eyelid blepharoptosis or contour abnormalities.

In five cases, a simplified anterior tarsal resection corrected complicated upper eyelid blepharoptosis and contour abnormalities. One case of residual blepharoptosis after levator muscle resection was corrected by resecting an amount of tarsus equal to the desired amount of correction. Two cases of upper eyelid blepharoptosis resulting from overcorrected levator muscle recession were corrected in the same manner. In one case of residual segmental blepharoptosis of the upper eyelid causing a contour abnormality, we resected a segment of tarsus corresponding to the amount of blepharoptosis in the affected segment of the eyelid. In one patient who developed a contour abnormality after a Fasanella procedure with segmental blepharoptosis nasally and overcorrection temporally, a segment of tarsus resected nasally and inserted temporally created an even contour. Anterior tarsal resection is a simple method of revising the upper eyelid level of contour in situations where the upper eyelid anatomy has been distorted by previous surgery.

Adult

Levator tuck: a simplified blepharoptosis procedure.

A simplified technique for tucking the levator palpebrae superioris aponeurosis and muscle in the correction of blepharoptosis is described. The anterior (skin) approach is used and no special instruments are required. The advantages of this procedure are discussed, including preservation of the normal anatomy as much as possible, minimum dissection and minimum edema. A preliminary number of cases are reported. It is believed that this technique is useful in cases of acquired blepharoptosis and in congenital blepharoptosis with good levator function.

Anesthesia, General

Cortical blepharoptosis.

A 59-year-old man with a previous left frontal lobe infarction sustained an infarction of the right frontal lobe. The patient manifested a bilateral symmetrical blepharoptosis that resolved in two months. Eyelid movements seem to be bilaterally represented in the frontal lobes. Bilateral cortical disease can produce supranuclear eyelid abnormalities such as blepharoptosis, difficulty maintaining eyelid position, and difficulty initiating eyelid movement.

Blepharoptosis

Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis.

A new technique for resecting the Müller muscle and the conjunctiva for correction of blepharoptosis has been developed. The operation is performed on all patients in whom a 10% phenylephrine hydrochloride solution instilled in the conjunctival cul-de-sac will elevate the blepharoptotic eyelid to a cosmetically acceptable level. The results of the surgery have been satisfactory in 27 of 28 operated eyelids.

Adolescent

Blepharoptosis correction with the sutureless Fasanella-Servat operation.

The Fasanella-Servat operation for correction of blepharoptosis in cases where the function of the levator muscle is good can be performed effectively without the use of sutures, thus eliminating the possible complication of corneal abrasion in the postoperative period. The author has performed 12 sutureless operations with satisfactory correction in 11 cases.

Blepharoptosis

Blepharoptosis after traumatic third-nerve palsies.

We evaluated the clinical records of 16 patients with blepharoptosis secondary to direct traumatic third-nerve palsies. Most patients were involved in auto accidents, and had associated skull fractures. Of 12 patients who were followed up for at least one year, ten recovered completely. Over half of the patients had evidence of aberrant regeneration, which could be seen clinically as early as nine weeks after the trauma. Orbital localization of the third-nerve dysfunction carries an excellent prognosis for prompt, spontaneous recovery without aberrant regeneration. Surgical intervention in these cases should be delayed at least one year after the traumatic event, and longer if continued slow but progressive recovery is demonstrated.

Adolescent

Superior tarsal muscle resection to correct blepharoptosis.

Resection of the superior tarsal muscle (STM) is effective in correcting congenital or acquired blepharoptosis in patients who have satisfactory elevation of the eyelid with a preoperative phenylephrine eye drops test. Advantages of this procedure are that only the STM is resected, the conjunctiva and basic lacrimal secretors are preserved, tarsal stability is maintained, no special instruments are required, and the preoperative phenylephrine eye drops test reliably predicts the postoperative result.

Adult

Correction of senile (atonic) blepharoptosis during cosmetic blepharoplasty.

Pseudoptosis, caused by skin laxity or by herniation of periorbital fat, can be remedied by the usual cosmetic blepharoplasty. If there is a concomitant mild senile ptosis due to levator weakness, however, we recommend levator muscle plication during the course of the blepharoplasty. While blepharoptosis of significant degree is best treated by resection of the levator, plication works well in a mild degree of senile (or atonic) ptosis (when there is no more than two to 4 mm of droop). It is a simple and effective maneuver, easily performed in association with a cosmetic blepharoplasty.

Blepharoptosis

The necessary resection of the levator muscle of the upper eyelid in the operation for congenital blepharoptosis.

The authors comment on the excellent postoperative results obtained in 22 eyes operated on according to the Blaskovics method for congenital blepharoptosis. They discuss the length of the resected part of the levator muscle of the upper lid, the length depending in each case on the degree of the ptosis and on the functional ability of the levator muscle. They arrive at the conclusion that the shortening of the levator muscle must be considerably greater than heretofore advocated by the classical view.

Adolescent

A modified silicone frontalis sling for the correction of blepharoptosis.

We devised a frontalis sling by using two No. 40 silicone bands. Each free end was sutured to the tarsus and joined in the central brow area. We used pulley sutures in the medial and lateral brow incisions to prevent migration of the bands. With this method, adjustment of the eyelid level can be made anytime postoperatively through the central eyebrow incision because of the ease in finding the overlapped ends of the silicone bands. This is particularly useful for patients with chronic progressive ophthalmoplegia where poor closure and exposure keratopathy are potential postoperative problems.

Aged