My 4 Yr Old Had Frontalis Fascia Lata Sling Procedure and Want It Reversed

My 4yr old son had ptosis in the right eye (3-4mm). The levator muscle was weak but most of the time people couldn't even notice the ptosis. We patched prior to the surgery but was told the vision was getting worse. Post surgery he blinks only with the good eye, when looking down the affected eye looks open so it looks very unnatural. I'm so devastated and want to know if it can be reversed. Please help me! I don't know how to post photos but can email it to anyone that can help me!

Doctor Answers 2

Reversal of frontalis sling procedure in 4 year old

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Certainly, you can have this procedure reversed.  The better question to ask yourself is should you?

Your child must develop normal binocular vision by age 6 and after this it is too late. A droopy upper lid often prevents this from occurring.  Reversing the procedure at this age may result in PERMANENT loss of vision and this seems secondary to cosmetic concerns at this time.  The concerns you relate are not complications of the procedure but actually are anticipated consequences and you may have been less "devastated" had you been forewarned that this would be the case.  The treatment of severe unilateral ptosis with poor levator function is controversial (doctors argue among themselves whether to perform unilateral or bilateral surgery in these cases), and expectations of perfect symmetry in all fields of gaze are simply unrealistic.  A second opinion with an oculofacial plastic surgeon or a pediatric ophthalmologist might be beneficial.

Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 138 reviews

Let's try to break this down with the limited information you have provided.

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Your son has congential ptosis of the right eye that is severe enough that it is causing ambyopia (lazy eye).  This occurs when visual development of the eye is imparied which can be caused by strabismus (misalignment of the eyes), congenital cataract, or a droopy eye lid that blocks or partially blocks the pupil, to name a few causes.  There is a limited window for proper neurological development of the visual pathways.  This makes early correction of this type of ptosis critical.  Patching of the good eye  forces the child to use the weak eye.  By consistently doing this, the weaker eye is strengthened.  This type of patching must be monitored closely by a pediatric ophthamologist.  Congential ptosis surgery at this age is not cosmetic surgery.  The goal is an eye that is sufficiently open as to permit the necessary visual rehabilitation of the amblyopic eye.  These situations are never perfect.  The operated eyelid will hang up in down gaze.  The key is to be certain that the corneal surface stays compensated.  A skilled pediatric ophthalmologist will be able to assess this.  If you live in a developed country, I recommend that you take you child to a University Medical Center for a second opinion with a pediatric ophthalmologist who performs frontalis suspension surgery for this purpose.  Do not take you child to such a center unless they have precisely this type of surgeon so you do not waste your time and money.  It is likely that you current surgeon can help you arrange this opinion.  Please stay on good terms with your local ophthalmologists.  These may very well be the doctors who will have to care for your child on a day to day basis despite your concerns regarding their treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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