[Choice of treatment in surgery of congenital ptosis]

Because of the great variety of congenital ptosis and surgical procedures, the choice of a definite surgical protocol is rather difficult. The author reports here three surgical techniques which have been used for over 5 years. The levator muscle resection with upper lid fold reconstruction via a skin approach is still the preferred technique in most cases. The main problem is to determine the magnitude of muscle resection which is directly related to the levator function. Frontalis suspension with autogenous fascia-lata or synthetic materials as Goretex is performed in case of levator resection failure: non-functioning muscle, muscular dysfunction as in the Marcus Gunn syndrome. The conjunctiva-Müller's muscle excision avoiding overcorrection is indicated in cases of minor congenital ptosis with good muscular function and positive response to topical 10% epinephrine drops.