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Vertical Tarsal Plate Buckling Following Conjunctival Mullerectomy: An Unusual Complication
Mario Cale1, Brian C Tse, David T Tse
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida, USA.
Ophthalmic Plastic and Reconstructive Surgery
|February 13, 2026
Summary
Conjunctival mullerectomy can cause upper eyelid tarsal plate buckling due to muscle-tissue imbalance. Surgeons must consider all eyelid forces before ptosis surgery to prevent complications.
Area of Science:
- Ophthalmology
- Ophthalmic Surgery
Background:
- Conjunctival mullerectomy is a surgical procedure to treat ptosis.
- Vertical tarsal plate buckling is a rare but significant complication.
Purpose of the Study:
- To report a case of vertical tarsal plate buckling after conjunctival mullerectomy.
- To analyze the biomechanical mechanism of this complication.
Main Methods:
- Case report of a 75-year-old patient.
- Clinical examination of eyelid laxity and instability.
- Analysis of surgical and anatomical factors.
Main Results:
- The patient presented with bilateral upper eyelid vertical tarsal plate buckling.
- Significant lid laxity and lateral canthal tendon instability were noted.
- The complication was attributed to an imbalance of forces.
Conclusions:
- Vertical tarsal plate buckling can occur after conjunctival mullerectomy.
- Understanding the interplay of vertical and horizontal forces is crucial.
- Careful preoperative assessment of eyelid anatomy is essential for ptosis surgery.
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