The authors describe a surgical technique to manage congenital ptosis. They present 30 patients with severe congenital ptosis, MRD1 varying between -2mm and 1mm. Intervention was carried out early to prevent amblyopia. All cases had surgery before age seven with 72% age two or less. The surgical technique involves accessing the frontalis muscle through an upper eyelid skin crease incision then fashioning a flap lateral to the supra orbital neurovascular bundle based laterally. The frontalis flap is then rotated inferiorly and fixed to the tarsal plate. Results were good with all patients having their visual axis cleared at last follow-up (mean follow-up of 27 months) and no sight-threatening complications noted. Three patients required reoperation. The technique offers a useful alternative to more established techniques for managing congenital ptosis which required only one incision, and no foreign material.

Early frontalis flap surgery as first option to correct congenital ptosis with poor levator function.
Medel R, Vasquez L, Wolley Dod C.
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Konal Saha

Queen Victoria Hospital, East Grinstead, UK.

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