A 1-year-old boy has dense bilateral congenital ptosis with chin-up head posture and poor brow elevation. Levator function measured on downgaze-to-upgaze excursion is 3 mm bilaterally. Which surgical procedure offers the BEST functional correction?

• A Frontalis sling suspension ✓
• B Levator aponeurotic advancement
• C Levator resection, moderate
• D Fasanella-Servat operation

Explanation

Congenital ptosis is myogenic, caused by dystrophic development of the levator palpebrae superioris, and levator function directly dictates surgery. When levator function is poor (4 mm or less), the levator cannot elevate the lid regardless of shortening, so the frontalis sling transfers brow elevation force to the tarsal plate. Levator resection requires fair to good function, and Fasanella-Servat is reserved for minimal ptosis with excellent function.

Reference: AAO Basic and Clinical Science Course, Section 7: Orbit, Eyelids, and Lacrimal System, 2023-2024 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.