This is a description of a surgical technique which simultaneously addresses both the upper lid ptosis and lower lid retraction in patients with moderate to severe myopathic ptosis. The procedure was performed on 16 eyes of nine patients and involved excision of an 8mm height portion of posterior lamella from the upper lid including tarsal plate and Muller’s muscle. Direct closure of this rectified the upper lid ptosis and the excised tissue was then placed as a spacer graft below the tarsal plate of the lower lid to elevate it. Upper lid ptosis was corrected by an average of 2.3mm, and lower lid retraction was reduced by an average of 1.6mm. No patient suffered from significant corneal exposure despite all patients having weak orbicularis function, reduced eye movements and a poor Bell’s phenomenon. In addition to elevation of the lower lid, the importance of not disrupting the orbicularis by an anterior approach ptosis repair is emphasised. Previous similar studies have reported a residual medial ptosis and the authors state this can be avoided by resecting the whole length of the posterior lamellar. Although the numbers are small, the article provides good evidence for this being a safe and effective technique for ptosis correction in this difficult population.

The posterior approach tarsal switch procedure for myopathic ptosis: A modified technique.
Lenake MN, McNab AA.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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