Ptosis worse after ptosis repair! Muller without phenylephrine test? (Photo)

Question

I had mullerectomy done 3 months ago. I have congenital ptosis since the age of 3, currently I am 26, the eye with ptosis has high amblyopia (I can see only 25%), convergent strabismus and hyperopic astigmatism. Also, the eye is more fallen when I am tired or when I drink alcohol (lol). The problem is the surgeon did not perform the phenylephrine test to see if I am a suitable candidate for this technique. He said that this test has not been done for some time and is irrelevant in 2021.

Joseph Walrath, MD · Answer

Dear Fierce920723,
I am sorry that you had a bad experience. I don’t think it means that you had a bad surgeon, however. I find that the phenylephrine test is most useful, for me, as a teaching tool when discussing surgery with patients. I am not convinced that the quantitative outcome of the PE test really matters that much.
I do think you should proceed with standard external levator resection surgery, which is the preferred technique that I use for congenital ptosis with moderate to good function.
Best of luck,J Walrath

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