An Unexpected Conjunctival Prolapse Following Frontalis Muscle Flap Transfer for Severe Ptosis

Conjunctival prolapse may occur following ocular, eyelid, and orbital surgeries. Conjunctival prolapse usually results as a complication of maximal levator resection or cosmetic lower eyelid blepharoplasty. Here, we describe conjunctival prolapse as an unexpected complication of frontalis muscle flap transfer for severe ptosis. On postoperative day 5, the patient experienced upper eyelid swelling after closing his eyes suddenly and standing up abruptly. The conjunctiva was reddish and ballooned up, and they protruded over the eyelids. Conjunctival prolapse persisted until postoperative day 8. The patient and surgeon were concerned that this complication would affect ptosis correction and surgical outcome. U-shaped fixations were placed to suture and force the prolapsed conjunctiva back to their normal anatomical positions. At postoperative 6 months, the patient had not experienced additional issues, and he was satisfied with the appearance of his eyes. This report describes a rare clinical case of conjunctival prolapse and provides a reference for surgeons treating similar complications.