My 18 mo. old daughter had external levator resection to correct mild congenital ptosis 3 months ago. Her eye became worse. Now approx 1/2 pupil is covered and there is concern to prevent amblyopia. She still has good movement of her affected eyelid, and it completely closes (evidence of no lift from surgery). Her surgeon says she will need a silicone sling, that levator muscle cannot be lifted anymore. Is it possible that her existing eye muscle can be salvaged instead of sling procedure?
Ptosis Surgery Reoperation?
Doctor Answers 3
Congenital eyelid ptosis
Congenital ptosis is very variable. It can me mild to severe. Depending on the level of ptosis and function/strength of the levator muscle (responsible for lifting the eyelid), various options are possible, including levator muscle tightening versus frontalis sling (whereby the forehead muscle, named frontalis, is linked to the upper eyelid, to assist in lifting the upper eyelid). See an oculoplastic surgeon for evaluation and management.
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Your question is fully understandable, especially since the situation has worsened since the procedure. First question: how much swelling is there? this can inhibit movement a lot, and should be gone completely before judging the current situation.
Second: is how much movement is left, and is this less then before the operation. If this is the case we should wonder whether the operation was done correctly or if their was a complication during or after the procedure. If so a repair attempt should be made.
Some children have very little muscle so it can be a very difficult operation, if your surgeon has much experience with this procedure he might be right and a sling procedure is the way to go.
From your question i deduct doubt of the current surgeon, a second opinion should be advised by one or several other doctors interested and experienced in this surgery. I personally find that redirecting patients to a particular group of specialists is not very ethical. We all know that there are experienced surgeons in different specialties......
It really depends on how much the levator muscle was shortened during the initial surgery, and what the amount of function is. If she has poor levator function [5 mm or less], then silicone sling is the technique of choice.
If she has fair levator function [5-10 mm] then levator surgery is a possibility, if it has not already been shortened.
If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.
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