Treatment of unilateral congenital ptosis: putting the debate to rest.

PURPOSE OF REVIEW: Frontalis suspension for the surgical correction of poor levator function congenital ptosis has been a matter of debate in the last decade, but recently progress has been made. This study highlights the relevant keystones regarding sling material, surgical steps, and approach that can improve functional and esthetic results, while minimizing risk to the eye.

RECENT FINDINGS: The incidence and demographics of ptosis in children have been reported by two recent studies confirming that unilateral, poor levator function congenital ptosis is the most common form, the left eye is most commonly affected, and frontalis suspension is the most commonly performed technique. Significant progress has been made concerning the sling material and the surgical technique of frontalis suspension. Although different surgical designs for sling suspension have proven to have no effect on the final result, a recent study has shown the importance of direct fixation with sutures of the sling material to the tarsal plate to increase the success rate Autologous fascia lata has been found to be an excellent sling material with the lowest complication rate and should be considered the preferred material for long-term correction. A review of the recent literature suggests that unilateral surgery is the preferred approach.

SUMMARY: Although the surgical treatment of simple congenital ptosis has not radically changed through the years, recent reports have established some keystones that can positively affect the esthetic outcomes and safety of frontalis suspension.