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Levator Aponeurosis Dehiscence: External Levator Advancement

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Abstract

Dehiscence of levator aponeurosis was historically viewed as the exclusive cause of acquired blepharoptosis with normal levator function. In reality, acquired blepharoptosis with normal levator function is likely triggered by many factors including levator aponeurosis dehiscence from the anterior face of tarsus, stretching of the aponeurosis, and/or fatty infiltration of levator muscle. Irrespective of the underlining pathophysiology, external advancement of levator aponeurosis can effectively treat acquired blepharoptosis with normal levator function. Even in experienced hands, especially when an eyelid has been previously operated or there is significant fatty infiltration of levator muscle, external levator advancement can be a challenging operation. The main steps of this surgery are as follows: identification of the anterior face of levator aponeurosis, complete disinsertion of levator aponeurosis from its insertion on tarsus, advancement of the free edge of aponeurosis, and reattachment of this edge onto tarsus.

Keywords

  • Blepharoptosis
  • Dehiscence
  • Levator aponeurosis
  • External advancement

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Correspondence to Evan Kalin-Hajdu .

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Electronic Supplementary Material

Video 19.1

External levator advancement for repair of ptosis. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/External-levator-advancement.htm (MP4 194936 kb)

Video 19.2

Levator advancement. Courtesy of Richard C. Allen, MD, PhD, FACS. http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/6/5-levator-advancement.htm (MP4 229907 kb)

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Kalin-Hajdu, E., Hirabayashi, K.E., Kersten, R.C. (2018). Levator Aponeurosis Dehiscence: External Levator Advancement. In: Levine, M., Allen, R. (eds) Manual of Oculoplastic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-74512-1_19

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  • DOI: https://doi.org/10.1007/978-3-319-74512-1_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74511-4

  • Online ISBN: 978-3-319-74512-1

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