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Frontalis Suspension Blepharoptosis Repair

Frontalis suspension blepharoptosis repair is the procedure of choice for the repair of blepharoptosis in the context of poor levator function (< 4mm). Numerous sling materials have been described for this procedure, however, preferred materials include banked, Tutoplast or autologous fascia lata, or silicone rods. This video demonstrates frontalis suspension utilizing silicone rods. Authors: Jay C. Wang, MD (Massachusetts Eye and Ear) Suzanne K. Freitag, MD (Massachusetts Eye and Ear)

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
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
Advantages: Procedure of choice for ptosis repair in context of poor levator function, minimal postoperative cosmetic deformity, adjustments possible with use of silicone rods Disadvantages: Risk for overcorrection and exposure keratopathy, risk for infection or reaction to sling material
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.
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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.

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