A 40-year-old presents with unilateral ptosis, MRD1 of 1 mm, levator function of 4 mm, and a poor lid crease. The MOST appropriate surgical procedure is:
- A Frontalis sling (brow suspension) ✓
- B Fasanella-Servat tarsoconjunctival resection
- C Levator aponeurosis advancement
- D Müller muscle–conjunctival resection
Correct answer: A. Frontalis sling (brow suspension)
Explanation
Frontalis sling is indicated for severe ptosis (MRD1 ≤1 mm) with poor levator function (≤4 mm), using the frontalis muscle to elevate the lid. Levator aponeurosis advancement is appropriate when levator function is fair-to-good (≥5 mm). Müller muscle–conjunctival resection (MMCR) is used for mild-moderate ptosis with good levator function and a positive phenylephrine test. Fasanella-Servat is reserved for minimal ptosis (≤2 mm) with good levator function.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.