Split Level Lid Resection for the Correction of Moderate Congenital Ptosis

Lee, Kun Chang; Roh, Tai Suk; Park, Chul; Oh, Suk Joon; Park, Beyoung Yun

Abstract

Split-lid excision with or without levator hitching has been experienced in the correction of mild to moderate blepharoptosis in 18 lids in 15 patients. 12 patients were unilateral and 3 patients were bilateral. Split level resection was performed in cases of levator function of more than 7mm, whereas 5-6mm of levator function was addressed with additional levator hitching as described by Mustarde. In patients with a moderate degree of ptosis, the authors split the lid vertically into two layers and resected a horizontal block of full-thickness upper eyelid at two different levels. Most of the tarsal plate with its overlying conjunctiva was removed from one layer and, at a higher site, a corresponding amount of skin and orbicularis from the other. In patients with more severe degree of ptosis, the authors achieved levator complex shortening by folding some of the levator complex upward on itself after split-lid excision procedure. Undercorrection was seen in 4 lids, and lid lag on downward gaze was observed in 6 lids. In contrast, overcorrection or significant lagophthalmos at primary gaze could not be seen. Except for lid edema which abated during the ensuing several months, troublesome complication was not observed. It can be safely said from this that split-lid excision technique with or without levator hitching is a reasonable option in the correction of mild to moderate forms of blepharoptosis.