Comparison of eyelid function following frontalis suspension and levator dissection-resection in congenital ptosis with poor levator function.

Purpose: A levator dissection-resection technique (LDR) in which the levator is dissected free from all fibrous attachments including Whitnall's ligament was compared to two commonly used frontalis-based procedures in the management of congenital ptosis with poor levator function.

Methods: Thirty patients having congenital ptosis with poor levator function were randomized to one of the three surgical groups (ten patients for each group), namely, frontalis sling (FS), frontalis advancement flap (FAF), and (LDR) technique. Marginal reflex distance-one (MRD-1), levator function, symmetry in different levels of vertical gaze, lagophthalmos, and any other surgical complications were assessed 6 months following the intervention.

Results: Patients in the three groups achieved statistically significant improvement in MRD-1 in the primary position of gaze (p = 0.001 for FS, 0.003 for FAF, 0.001 for LDR). Patients who underwent a frontalis-based procedure acquired an additional ability to elevate the upper eyelid by using their eyebrows. Patients who underwent LDR technique have acquired an additional mean of 5.79 ± 1 mm improvement in levator function with better symmetry during up and down gaze in unilateral cases. Patients from all groups had an equal degree of lagophthalmos with forced eyelid closure, and during sleep.

Conclusion: Patients with ptosis and poor levator function who were managed with LDR technique achieved a similar degree of eyelid elevation in the primary gaze to that of frontalis-based procedures, acquired additional levator function, achieved more symmetry in up and down gaze in unilateral cases, and had no additional risk to the cornea.