A 68-year-old man notices drooping of both upper lids that is worse towards the end of the day. He had cataract surgery two years ago. Levator function measures 12 mm bilaterally and the upper lid crease sits abnormally high. The MOST appropriate surgical procedure is:

• A Frontalis sling suspension
• B Muller muscle-conjunctival resection
• C Levator resection of 20 mm or more
• D Levator aponeurosis advancement ✓

Explanation

Good levator function with a high lid crease and onset after intraocular surgery defines aponeurotic ptosis, caused by dehiscence or disinsertion of the levator aponeurosis. Repair consists of advancing the aponeurosis onto the tarsal plate. Large levator resection and frontalis slings are reserved for congenital ptosis with poor levator function, while Muller resection suits mild ptosis with excellent levator function and a positive phenylephrine test.

Reference: Kanski's Clinical Ophthalmology, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.