Correction of myopathic blepharoptosis by check ligament suspension: Clinical evaluation of 89 eyelids

Myopathic blepharoptosis is a congenital anomaly of the eyelid. The levator muscle does not function because of primary myogenic atrophy. Different procedures based on eyelid suspension, or the simple or combined resection of the eyelid have been described. A simple dynamic suspension of the tarsus to the check ligament of the superior fornix, neither sacrificing nor adding any tissue was used for 89 procedures on 71 consecutive patients with primary myopathic blepharoptosis. Their mean age at operation was 16 years (range 2-58) and the follow up ranged from 2 months to 12 years. Ptosis was unilateral in 53 patients (33 left, 20 right) and bilateral in 18. Preoperatively 27 had mild ptosis (1-2 mm), 33 moderate (3-4 mm), and 29 severe (>4 mm). The patients were divided into two groups: not previously operated on (50 patients/63 eyelids) and previously operated on by other techniques (21 patients/26 eyelids); both groups were compared for duration of procedure, normalisation rate, and number of revisions. In the unoperated group the normalisation rate was 81% (51 eyelids), and to achieve a good final result nine eyelids were revised once, while just three were reoperated on twice (19%). In the group previously operated on the normalisation rate was 69% (18 eyelids), while 3 eyelids needed one revision (12%). In unilateral cases the normalisation rate was 79% (42 eyelids) and in bilateral 75% (27 eyelids). In unilateral blepharoptosis there were 13% of revisions (7 eyelids) while bilaterally there were 22% (8 eyelids). Despite a previous operation, the operating time of a unilateral correction was similar in both groups, while the number of revisions needed to achieve the final result was low for unilateral ptosis, but higher for bilateral ones. This simple atraumatic suspension technique produced an improvement in all cases and it seemed useful in both primary and secondary cases