A 6-year-old boy is referred for unilateral congenital ptosis. Levator function measures 3 mm. MRD1 is 0 mm (upper eyelid covers the pupil). Amblyopia is present. What is the BEST surgical option?

• A Fasanella-Servat procedure
• B Levator resection via anterior (skin crease) approach
• C Frontalis sling (brow suspension) surgery ✓
• D Müller's muscle-conjunctival resection

Explanation

Severe congenital ptosis with poor levator function (≤4 mm) requires frontalis sling surgery, which uses the frontalis muscle as an alternative elevator by suspending the upper eyelid to the frontalis via a sling material (autologous fascia lata or synthetic). Fasanella-Servat (Müller's resection) is for mild ptosis with good levator function and a positive phenylephrine test. Levator resection is for moderate ptosis with levator function >4 mm. Müller's muscle-conjunctival resection is similarly reserved for mild ptosis with a positive phenylephrine test.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.