A child with congenital ptosis is referred for evaluation. The margin reflex distance-1 (MRD1) is 0 mm (corneal light reflex at upper lid margin) and levator function is 2 mm. The preferred surgical procedure is:

• A Frontalis sling using autogenous fascia lata ✓
• B Aponeurotic ptosis repair (levator resection)
• C Müller's muscle-conjunctival resection (Fasanella-Servat)
• D Putterman procedure

Explanation

Congenital ptosis with poor levator function (less than 4 mm) requires frontalis sling surgery because the levator muscle is dysplastic and insufficient for direct resection. Autogenous fascia lata harvested from the thigh is the gold standard sling material, particularly in children over 3 years when the thigh is large enough. Levator resection and Müller's resection require adequate levator function (>4 mm). Fasanella-Servat is reserved for mild ptosis (1–2 mm) with good levator function.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.