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Ptosis Repair, Mullerectomy

Suzanne Freitag MD

Juan Carlos Jimenez Perez, MD

Benjamin Jastrzembski, MD

Harvard Medical School, Massachusetts Eye and Ear

Mullerectomy (Putterman müllerectomy, Müller muscle resection)
Repair of upper eyelid ptosis of up to 2mm
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In the clinic, 2.5% phenylephrine hydrochloride is instilled into the eye with the ptotic upper eyelid. Adequate upper eyelid position fifteen minutes following the instillation of the drop suggests the ptosis is amenable to repair with the mullerectomy procedure. The marginal reflex distance (MRD1) should be determined before and after the instillation of phenylephrine. The use of a flash photograph is very helpful in documenting an improvement in eyelid position with phenylephrine.
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With the internal transconjunctival approach of the mullerectomy, there is no skin incision or external sutures following the procedure. The principle disadvantage of the mullerectomy procedure is that it may be used only to repair minimal ptosis of up to 2mm.
Potential complications include undercorrection of the ptosis and lagophthalmos with risk of subsequent exposure keratopathy.
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