DOI: 10.1097/IOP.0b013e3181b8ed5e
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Issn Print: 0740-9303
Publication Date: 2010/03/01
Re: “The Levator Aponeurosis Exposed”
Excerpt
I wish to comment on the brief report “The Levator Aponeurosis Exposed” by Rebecca R. Stack et al.1 I think the case points up some of the challenges still facing the ptosis surgeon. The “before” photo with deep superior sulci and significant inferior scleral show indicates a degree of enophthalmos. Exophthalmometer readings were not reported. Orbicularis function need not be very strong to achieve closure, as known from attempts to extirpate the orbicularis muscle in blepharospasm cases. Loss of the facial nerve is a very different situation, as is severe myasthenia gravis. The 2 photographs are not properly comparable. The size and the exposure brightness are not the same. The patient's head position in the postoperative view shows the nose up and the ears down. The lower limbus is also seen lower—the preoperative scleral show is no longer evident. The preoperative photo shows the lateral canthi to be low. This and the attempt to recreate the upper eyelid crease might possibly produce some tethering of the eyelids. Lateral canthal suspension might be helpful in such situations. Although not necessarily appropriate in this patient, consideration should be given to correction of the enophthalmos. A satisfied patient is always gratifying, but our criteria should be met as well. I am interested in the comments from the authors and others.
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