Ptosis Correction: Our Modification and Experience

Background Congenital ptosis not only results in an asymmetric facial appearance but can lead to permanent visual disturbances if not addressed at an appropriate time. Crawford used fascia lata for suspension of the eyelid to frontalis muscle, which remains a standard procedure for congenital ptosis correction to date, with an acceptable recurrence rate due to graft slippage. There are many modifications in this technique to reduce this complication; hence, in this study, we share our experience of a modification to improve the outcomes. Methodology This retrospective study was conducted at a private tertiary care hospital in Karachi for 10 years. In total, 26 patients fulfilled our inclusion criteria. All patients underwent a modified Crawford's procedure under general anesthesia. Results In this study, the male-to-female ratio was 1:1.5. In total, 17 (65%) patients had unilateral ptosis. The mean age of presentation was 7 ± 3 years. All of our patients had poor levator function (<5 mm excursion) with a mean of 3 mm and mean grade of ptosis of 4 ± 1.6 mm. The mean preoperative marginal reflex distance (MRD) was +1.8 ± 0.6 mm. In this study, the patients had a mean postoperative MRD of 4.2 ± 0.7 mm at the four-week follow-up. Conclusions Although Crawford's procedure gives promising results for ptosis correction, suturing the fascial sling to the tarsal plate ensures good anchorage and prevents relapse.