Severe blepharoptosis: correction by orbicularis oculi muscle and orbital septum resection and advancement

Using a concept based on cadaveric dissections that the orbital septum could suspend the tarsal plate statically and that the shortened orbicularis oculi muscle would then transmit the frontalis muscle action more effectively, the orbicularis oculi muscle and the orbital septum were advanced to the tarsal plate as a single flap for the correction of blepharoptosis with poor or absent levator function. The redundant portion of the distal flap was resected. From March 1991 to December 1994, 17 patients (24 eyelids) underwent surgery for blepharoptosis with this procedure. Eleven patients were male, and 7 patients had bilateral blepharoptosis. All patients had less than 3 mm of levator function. Patient follow-up ranged from 17 to 52 months, with an average of 35 months. The postoperative result was arbitrarily defined as good when the amount of ptosis was less than 2 mm, fair when the amount of ptosis was 2 to 3 mm, and poor when the amount of ptosis was more than 3 mm. Twelve patients (71%) had good results and 2 patients had fair results. The remaining 3 patients (18%) showed poor results, and reoperation was done with good results in 1 patient and fair results in the other 2 patients. This procedure has several remarkable merits. It is a simple technique with good operative exposure through a single incision at the upper tarsal margin, and it preserves the function of both the frontalis and orbicularis oculi muscles. The main drawback was mild drooping of the upper eyelid for a period of time, so some overcorrection was necessary.