Frontalis Suspension Blepharoptosis Repair

Originally described by Payrin in 1909 and Wright in 1922.
Crawford introduced use of autologous fascia lata in 1956.

Blepharoptosis with poor levator function such as in cases of congenital ptosis, traumatic ptosis, or neurogenic ptosis

Lagophthalmos, exposure keratopathy, normal levator function, poor frontalis function

N/A

Special equipment:
Wright needle
Silicone sling with sleeve (Frontalis Suspension Set, Beaver-Visitec, Waltham, MA)
5-0 prolene suture with small spatulated needle

Obtain history and perform thorough examination, measure MRD-1, check levator and frontalis muscle function, eyelid crease position, assess ocular motility, assess for lagophthlamos and/or exposure keratopathy

Lid crease, tarsus, brow cilia

Intraoperative:
Injury to cornea – avoid by taking partial thickness bites through tarsus and use of scleral shell.

Early:
Undercorrection, overcorrection, or asymmetry – use of silicone rods afford opportunity for adjustment.
Lagophthalmos and exposure keratopathy – may be treated with lubrication, sling can be loosened if needed.

Late:
Sling slippage/migration or breakage – avoid damaging sling during implantation.
Infection, exposure, or granuloma formation – avoid superficial placement of sling.

None

Payr E. Plastik mittels freier Faszientransplantation bei ptosis. Dtsch Med Wochenschr. 1909;35(822).

Wright W. The use of living sutures in the treatment of ptosis. Arch Ophthalmol. 1922;51:99–102.

Repair of ptosis using frontalis muscle and fascia lata. Crawford JS. Trans Am Acad Ophthalmol Otolaryngol. 1956 Sep-Oct; 60(5):672-8.

Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. 1996;103(4):623-30.