Frontalis slings are performed on patients with ptosis who have decreased or poor movement of their levator muscle (the one that normally opens the eyelid). This mainly is done for patients with congenital ptosis, ptosis due to 3rd cranial nerve paralysis or progressive muscle weakening diseases. The procedure is basically a compromise. In order to get the eyelid up, if must be attached to the frontalis muscle (the one that raises the eyebrow). Since it is attached to the frontalis muscle, it makes closure of the eye more difficult. The eye may not close all the way especially when sleeping. Spontaneous blinking during the day is also limited to a variable degree. Options for comfort include: frequent use of lubrication (artificial tears, Natures Tears Eye Mist if drops are too hard or inconvenient to use, or something similar) during the day. Using lubricating eye ointment when sleeping helps keep the eye from drying out at night. There are moisture chambers that act like a green house to keep the eye from drying out at night which can be used with the ointment. Wearing protective sun glasses with side protectors keeps the eye more comfortable from the evaporative effects of bright sunlight and wind. It sometimes seems counterintuitive to wet an eye that is tearing. What is happening is the eye is drying out, the corneal nerves are telling the brain the eye is drying out and to make extra tears to keep the eye moist and protected.The discomfort is due to the drying. Surgical options include relaxing the upper eyelid to a lower position or raising the lower eyelid to decrease the amount of opening with or without lowering the upper eyelid.
