Management of Acquired Ptosis

  • John D. SiddensEmail author
  • Sonya D. Mitchell
  • Geoffrey J. Gladstone


Ptosis surgery may be performed alone or in conjunction with other oculoplastic procedures. Ptosis surgery may be performed under general anesthesia, but paralysis of the eyelid muscles makes postoperative prediction of the final eyelid position extremely difficult and postoperative success less predictable [1]. Local anesthesia is the standard delivery method because it is associated with decreased bleeding, decreased patient cost, decreased stress on the airway and cardiovascular system, and a shortened recovery time [2, 3]. The use of short-acting intravenous anesthesia and local anesthetic has allowed ptosis surgery to become much more accurate because the process is performed on dynamic tissue and anatomic structures are much more easily identified [3]. In this situation, the action of the levator muscle is not impaired, and the effect of the aponeurotic repair may be assessed during surgery.


Fascia Lata Eyelid Margin Orbicularis Muscle Orbital Septum Levator Function 
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  1. 1.
    Beard C. The surgical treatment of blepharoptosis: a quantitative approach. Trans Am Ophthalmol Soc. 1966;54:401.Google Scholar
  2. 2.
    Lindberg JV, Vasquez RS, Chao G-M. Aponeurotic ptosis repair under local anesthesia. Predictional results from operative lid height. Ophthalmology. 1988;95:1046.CrossRefGoogle Scholar
  3. 3.
    Metzinger SE et al. Local anesthesia in blepharoplasty: a new look? South Med J. 1994;87:225.PubMedCrossRefGoogle Scholar
  4. 4.
    Katzen LB. Anesthesia analgesia, and amnesia. In: Putterman AM, editor. Cosmetic oculoplastic surgery. 2nd ed. Philadelphia: WB Saunders; 1993.Google Scholar
  5. 5.
    Beard C. Ptosis. 2nd ed. St. Louis: CV Mosby; 1976.Google Scholar
  6. 6.
    Dransar HN. Un cas blepharoptose opere par un procede special a l’auteur. Ann Ocul. 1880;84:88.Google Scholar
  7. 7.
    Koster W. De verhouding van den musculus tarsalis superior mulleri bij ptosis congenita. Ned Tijdschr Geneeskd. 1899;35:412.Google Scholar
  8. 8.
    Reese RG. An operation for blepharoptosis with formation of a fold in the lid. Arch Ophthalmol. 1924;53:26.Google Scholar
  9. 9.
    Crawford JS. Repair of ptosis using frontalis muscle and fascia lata. Trans Am Acad Ophthalmol Otolaryngol. 1956;60:672.PubMedGoogle Scholar
  10. 10.
    Crawford JS. Repair of ptosis using frontalis muscle and fascia lata: a 20-year review. Ophthalmic Surg. 1977;8:31.PubMedGoogle Scholar
  11. 11.
    Tillett CW, Tillett AM. Silicone sling in the correction of ptosis. Am J Ophthalmol. 1966;62:521.PubMedGoogle Scholar
  12. 12.
    Beyer CK, Albert DM. The use and fate of fascia lata and sclera in ophthalmic plastic and reconstructive surgery. Ophthalmology. 1981;88:869.PubMedCrossRefGoogle Scholar
  13. 13.
    Downes RN, Collin JRO. The Mersiline mesh sling – a new concept in ptosis surgery. Br J Ophthalmol. 1989;73:498.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ruban JM et al. A new biomaterial in surgery of ptosis with frontalis suspension: wide pore PTFE. J Fr Ophthalmol. 1995;18:207.Google Scholar
  15. 15.
    Spoor TC, Kwitko GM. Blepharoptosis repair by fascia lata suspension with direct tarsal and frontalis fixation. Am J Ophthalmol. 1990;109:314.PubMedGoogle Scholar
  16. 16.
    Nesi FA, Waltz KL. Blepharoptosis. In: Nesi FA, Waltz KL, editors. Smith’s practical techniques in ophthalmic plastic surgery. St. Louis: CV Mosby; 1994.Google Scholar
  17. 17.
    Antoszyk SH et al. Interlocking Crawford triangles in frontalis suspension. Arch Ophthalmol. 1993;111:875.PubMedCrossRefGoogle Scholar
  18. 18.
    Dutton JJ. Atlas of ophthalmic surgery, vol II: oculoplastic, lacrimal, and orbital surgery. Mosby-Year Book. St. Louis: CV Mosby; 1992.Google Scholar
  19. 19.
    Eversbusch O. Zur operation der congenitalen blepharoptosis. Klin Monatsbl Augenheilkd. 1883;21:100.Google Scholar
  20. 20.
    Wolff H. Die vorlagerung des Musc. Levator pal. Superioris mit Plurchtrengnung der Insertion. Zwei neue Methoden gegen Ptosis congenita. Arch Augenheilkd. 1896;33:125.Google Scholar
  21. 21.
    Anderson RL, Beard C. The levator aponeurosis; attachments and their clinical significance. Arch Ophthalmol. 1977;95:1437.PubMedCrossRefGoogle Scholar
  22. 22.
    Anderson RL, Dixon RS. Aponeurotic ptosis surgery. Arch Ophthalmol. 1979;97:1123.PubMedCrossRefGoogle Scholar
  23. 23.
    Berke RN. A simplified Blaskovics operation for blepharoptosis. Arch Ophthalmol. 1952;48:460.CrossRefGoogle Scholar
  24. 24.
    Jones LT, Quickert MW, Wobig JL. The cure of ptosis by aponeurosis repair. Arch Ophthalmol. 1975;93:629.PubMedCrossRefGoogle Scholar
  25. 25.
    Older JJ. Levator aponeurosis surgery for the correction of acquired ptosis: analysis of 113 procedures. Ophthalmology. 1983;90:1056.PubMedCrossRefGoogle Scholar
  26. 26.
    McCord CD. An external minimal ptosis procedure – external tarsoaponeurotomy. Trans Am Acad Ophthalmol Otolaryngol. 1975;79:683.Google Scholar
  27. 27.
    Baylis HI, Shaw JN. Anterior tarsectomy reoperation for upper eyelid blepharoptosis or contour abnormalities. Am J Ophthalmol. 1977;84:67.PubMedGoogle Scholar
  28. 28.
    Collin JRO, O’Donnell BA. Adjustable sutures in eyelid surgery for ptosis and lid retraction. Br J Ophthalmol. 1994;75:167.CrossRefGoogle Scholar
  29. 29.
    Hylkema HA, Koorneef L. Treatment of ptosis by levator resection with adjustable suture via the anterior approach. Br J Ophthalmol. 1989;73:416.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Koresh JW. Multilevel full-thickness eyelid resection for the correction of severe acquired ptosis in the poorly functioning eyelid. Ophthalmic Surg. 1991;7:399.Google Scholar
  31. 31.
    Linberg JV, Mangano LM, Odom JV. Comparison of nonabsorbable and absorbable sutures for use in oculoplastic surgery. Ophthal Plast Reconstr Surg. 1991;7:1.PubMedCrossRefGoogle Scholar
  32. 32.
    Putterman AM, Urist MJ. Müller muscle-conjunctiva resection for treatment of blepharoptosis. Arch Ophthal. 1975;93:619–23.PubMedCrossRefGoogle Scholar
  33. 33.
    Ha SW, Lee JM, Jeung WF, Ahn HB. Clinical effects of conjunctiva-Müller muscle resection in anophthalmic ptosis. Korean J Ophthalmol. 2007;21(2):65–9.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External Levator advancement vs Müller’s muscle-conjunctival resection for correction of upper eyelid involutional ptosis. Am J Ophthalmol. 2005;140(3):426–32.PubMedCrossRefGoogle Scholar
  35. 35.
    Lake S, Mohammad-Ali FH, Khooshabeh R. Open sky Müller’s muscle-conjunctiva resection for ptosis surgery. Eye. 2003;17:1008–12.PubMedCrossRefGoogle Scholar
  36. 36.
    Khooshabeh R, Baldwin HC. Isolated Müller’s muscle resection for the correction of blepharoptosis. Eye. 2008;22:267–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • John D. Siddens
    • 1
    Email author
  • Sonya D. Mitchell
    • 2
  • Geoffrey J. Gladstone
    • 3
    • 4
    • 5
  1. 1.UMG Plastic Surgery, Greenville Hospital SystemGreenvilleUSA
  2. 2.Bassin Center for Facial Plastic SurgeryMelbourneUSA
  3. 3.Oakland University William Beaumont School of MedicineRoyal OakUSA
  4. 4.Department of Ophthalmology Kresge Eye InstituteWayne State University School of MedicineDetroitUSA
  5. 5.Consultants in Ophthalmic & Facial Plastic Surgery, P.C.SouthfieldUSA

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