Adjunctive Techniques to Traditional Advancement Procedures for Treating Severe Blepharoptosis

Background: To create a more physiologic eyelid opening in patients with severe blepharoptosis, the authors used lamina propria mucosa of conjunctiva, which continues to the check ligament of the superior fornix, in addition to levator aponeurosis and Muller's muscle as a composite flap. In patients with epicanthal folds with associated telecanthus, the authors also performed epicanthoplasty with medial canthal tendon shortening. Methods: Fifty blepharoptosis patients (85 eyelids) with a degree of ptosis of greater than 4 mm underwent the advancement technique using the levator aponeurosis-Muller's muscle-lamina propria mucosa of conjunctiva as a composite flap. Twenty-one (42 percent) of those patients also underwent split V-W epicanthoplasty and plication of the medial canthal tendon for epicanthal folds with associated telecanthus. Degree of ptosis and levator function were measured preoperatively and postoperatively. Results: Complete or near-complete correction of ptosis (degree of ptosis, <1 mm) was achieved in 54 eyelids (63.5 percent) and mild residual ptosis (degree of ptosis, 1 to 2 mm) was observed in 22 eyelids (25.9 percent) in postoperative follow-up after 6 months. The most common complication was reoperation, which was done in 15 eyelids (17.6 percent) because of incomplete correction. Conclusions: The advancement technique using the levator aponeurosis- Muller's muscle-lamina propria mucosa of conjunctiva composite was effective in the treatment of severe blepharoptosis with levator function of 2 to 7 mm. The technique produced elevating motion of the physiologic eyelid in a superior-posterior direction. There were no serious complications, such as long-term lagophthalmos or lid lag. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.