Super-maximum levator resection for severe unilateral congenital blepharoptosis

The treatment for severe unilateral blepharoptosis is controversial. Sixteen consecutive cases of severe unilateral blepharoptosis were studied: eight had a super-maximum levator muscle resection (30 mm or more) and eight had a bilateral brow suspension with excision of the normal levator. Cosmetically acceptable results were achieved in six of eight cases undergoing a super maximum levator resection. Disparity in the palpebral fissure in downgaze ranged from 3 to 6 mm and was not bothersome to either patient or parent. Postoperative complications such as hypotropia and conjunctival prolapse can be minimized with careful technique. Four to eight cases undergoing bilateral brow suspension with excision of the normal levator had residual ptosis. Brow scars were occasionally noticeable. Overall cosmesis was considered better in the super-maximum levator resection group compared to the frontalis sling group by unbiased observers. Super-maximum levator resection is a good alternative in the treatment of severe unilateral blepharoptosis for selected cases, particularly for those who fear manipulation of the normal eyelid.