Eyelid: Frontalis suspension

Abstract

The frontalis suspension procedure is most commonly performed in cases of congenital ptosis with poor levator function (<5 mm) and in adults with poor levator function. Due to the high incidence of concurrent amblyopia, patients should have a thorough ophthalmologic evaluation prior to surgery including a cycloplegic refraction to screen for meridional amblyopia or other refractive errors. Occasionally severe amblyopia can develop due to mechanical obstruction of the pupil from the ptotic eyelid, and therefore more urgent surgery may be indicated. In adult patients, myasthenia gravis should be ruled out as a cause of ptosis prior to surgery. Patients should have been evaluated and deemed appropriate for such surgical intervention. The amount of suspension performed depends on a number of factors including the degree of ptosis, the amount of levator function, and the risk for postoperative exposure keratopathy. Both alloplastic and autologous materials can be used to associate the frontalis muscle to the eyelid (this chapter will focus on silicone). Patients (or the patient's guardian) should have been educated about the risks and benefits of the procedure, including alternatives.