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Mild eyelid ptosis with good elevator function can be treated with minimally invasive procedures. When Muller’s muscle contraction corrects the deficiency (evaluated by phenilefrine test) conjunctivo-mullerectomy is the procedure of choice.
This video presents the surgical steps to perform conjunctivo-mullerectomy.
Contributors
Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Treatment of mild eyelid ptosis with conjunctivo-mullerectomy
mild eyelid ptosis with good function of elevator muscle and positive resposnse to phenilephrine eye drop test.
Absence or innefective function of Muller's muscle
Moderate or severe eyelid ptosis
General anesthesia through oral intubation.
Marking of the upper eyelid crease
Infiltration with local anesthetics and vasoconstrictor
Prep area with betadine
Eye protection
Clinical evaluation of eyelid ptosis degree and muscular function
Preoperative Phenilephrine Test
Upper eyelid crease
Eyelid eversion
Resection of 8mm of conjunctiva and Muller muscle
Tarsal preservation
N/A
Hematoma
Pain
Corneal abrasion
Insufficient result
Eyelid ptosis relapse
None
Fernando Rosas Brito for video and image editing
Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External levator advancement vs Müller's muscle-conjunctival resection for correction of upper eyelid involutional ptosis. Am J Ophthalmol. 2005 Sep;140(3):426-32.
Thomas GN, Chan J, Sundar G, Amrith S. Outcomes of levator advancement and Müller muscle-conjunctiva resection for the repair of upper eyelid ptosis. Orbit. 2017 Feb;36(1):39-42. doi: 10.1080/01676830.2017.1279650.
Review Treatment of mild eyelid ptosis with conjunctivo-mullerectomy.