A 5-year-old boy is brought with a painless, slowly progressive drooping of the right upper lid since birth, with a lid crease that is absent and poor levator function (2 mm). He has to tilt his head backward to see. The most appropriate surgical procedure is:

• A Levator resection (Everbusch or Berke procedure)
• B Frontalis sling (brow suspension) procedure ✓
• C Fasanella-Servat (Muller muscle-conjunctival resection) procedure
• D Aponeurotic ptosis repair

Explanation

Simple congenital ptosis with poor levator function (less than 4 mm) cannot be corrected by levator resection because there is insufficient levator muscle action to elevate the lid adequately. The frontalis sling procedure transfers the brow frontalis muscle action to the upper lid via a sling of fascia lata or silicone rod, allowing the child to open the lid by raising the brow. Surgery is ideally performed before 4–5 years to prevent amblyopia from stimulus deprivation.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.