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Choi and Kim: Frontalis Suspension Using a Silicone Rod in Blepharoptosis Patients with Poor Ocular Motility
Original Article

J Korean Ophthalmol Soc 2008;49(4):548-554.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.4.548

Frontalis Suspension Using a Silicone Rod in Blepharoptosis Patients with Poor Ocular Motility

Young-Joo Choi, M.D.1, Yoon-Duck Kim, M.D.2

1Department of Ophthalmology, Ulsan University School of Medicine, Ulsan University Hospital, Ulsan, Korea

2Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

Address reprint requests to Yoon-Duck Kim, M.D. Department of Ophthalmology, Samsung Medical Center, School of Medicine Sungkyunkwan University #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3568, Fax: 82-2-3410-0074, E-mail: ydkimoph@skku.edu

Received 31 January 2007       Accepted 25 October 2007

Copyright © 2008 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the efficacy of frontalis sling operation with silicone rods in patients with compromised corneal protective mechanisms.

Methods

The authors retrospectively studied 6 consecutive patients (7 eyelids) with severe blepharoptosis with poor ocular motility who had undergone frontalis sling operations using silicone rods.

Results

Preoperative diagnoses included third nerve palsy in 4 patients, double elevator palsy in 1 patient, and suspicious oculopharyngeal muscular dystrophy in 1 patient. With a mean follow‐ up of 27.7 months, a good final lid height was achieved in all 7 eyelids. Mild exposure keratopathy occurred postoperatively in 3 patients. During the follow-up period, no other significant complications, such as extrusion of the sling or infection, occurred.

Conclusions

Silicone rods are effective and safe materials for use in frontalis suspension in treating blepharoptosis in patients with inadequate or absent Bell's phenomenon, resulting in poor eye protective mechanisms associated with an increased incidence of corneal exposure.

Keywords: Absent Bell's, phenomenon, Blepharoptosis, Frontalis sling, Silicone rod

References

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Figure 1.
(A) Preoperative photography of a patient with double elevator palsy demonstrates visually significant left upper lid ptosis. Note the limitation of upgaze (B), lateral gaze (C) and down gaze (D). (E) Forty‐ two months after sling operation with silicone rod. (F) Good lid closure and absence of significant lagophthalmos.
jkos-49-548f1.tif
Figure 2.
(A) Preoperative photography of a 32‐ year‐ old woman with third nerve palsy, demonstrates visually significant left upper lid ptosis. Note the limited up gaze (B) and down gaze (D). (E) Same patient 12 months after sling operation with silicone rod (E). The left upper eyelid position was above the pupil and cosmetically acceptable. (F) Demonstrating good lid closure and absence of significant lagophthalmos.
jkos-49-548f2.tif
Table 1.
Clinical data for patients who underwent frontalis sling with silicone rod
Patient No. Age at surgery (years) Sex Associated disease Etiology Laterality Restriction of ocular motility
1 30 M Third nerve palsy congenial Right Elv. Dep.
2 31 M Third nerve palsy congenial Right Elv. Dep. Abd.
3 16 F Double elevator palsy congenial Left Elv. Dep. Abd.
4 32 F Third nerve palsy trauma Left Elv. Dep. Add.
5 17 F Third nerve palsy brain tumor op. Left Elv. Dep.
6 21 M R/O OPMD* acquired Both Elv. Dep. Abd. Add.

* OPMD = oculopharyngeal muscular dystrophy; Elv = elevation; Dep = depression; Abd = abduction; Add = adduction.

Table 2.
Surgical characteristics of patients underwent frontalis sling with silicone rod
Patient No. Previous ptosis surgery Previous Strabismus surgery Sling procedure Complication Follow-up (month)
1 Yes Yes Double rhomboid mild SPK＊ 29
2 No Yes pentagonal None 48
3 No Yes pentagonal mild SPK 42
4 No Yes pentagonal mild SPK 21
5 Yes No pentagonal None 20
6 No No pentagonal None 5

＊ SPK = superficial punctate keratopathy.

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