Upper eyelid ptosis surgery using a preparatory ocular prosthesis

PURPOSE: When an ocular prosthesis is unable to correct upper eyelid ptosis, surgery is performed with the existing prosthesis, which may be difficult and unsatisfactory. We used an alternative approach, in which the prosthesis was modified as a preparation to surgery. METHODS: This retrospective, noncomparative, interventional case series included 26 anophthalmic and 3 microphthalmic patients with unilateral, moderate to severe upper eyelid ptosis who underwent levator aponeurosis surgery via an anterior approach. Excluded were cases of congenital anophthalmos, contracted socket, and neurogenic ptosis. Before surgery, the prosthesis was modified to vertically align the pupils while neglecting the position of the upper eyelid. The outcome measures were palpebral fissure height and cosmetic appearance. RESULTS: The amount of ptosis before the procedure ranged from 1 to 6 mm (mean, 3 mm). After surgery, 24% (7 of 29) of patients received a minor adjustment to the preparatory prosthesis to improve the pupil or eyelid position. After the entire procedure, the ptosis was symmetrically corrected with the contralateral eye in 19 patients (66%), with 1 mm of residual ptosis in 6 patients (17%), and with 2 mm of residual ptosis in 4 patients (14%). No overcorrection was seen. CONCLUSION: The alternative sequence of a preparatory prosthesis before surgery provides good results in the correction of moderate to severe ptosis. © 2009 The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.