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From the Department of Ophthalmology, Bundang CHA Hospital, CHA University, College of Medicine, Seongnam, Republic of Korea.
The authors have no financial or proprietary interest in the materials presented herein.
Introduction
Blepharoptosis refers to vertical narrowing of the palpebral fissure secondary to drooping of the upper eyelid to a lower than normal position. It is considered to be congenital if present at birth or if diagnosed within the first year of life. Congenital ptosis is generally unilateral (70%) but may be bilateral, and can be isolated or associated with disease of one or more of the extraocular muscles and/or other systemic conditions. 1,2
Ptosis can also be seen as a component of many congenital syndromes, including Duane retraction syndrome, blepharophimosis ptosis epicanthus inversus syndrome, congenital fibrosis of extraocular muscles, Marcus-Gunn jaw winking syndrome, and congenital Horner's syndrome. 3
Congenital ptosis is generally considered a non-progressive condition; however, it is associated with the development of visual disturbances such as myopia, astigmatism, anisometropia, amblyopia, ocular torticollis, and strabismus. These sequelae of ptosis provide a compelling reason to pursue early surgical correction. 4,5
One surgical approach to patients with congenital ptosis and poor levator function or congenital Marcus-Gunn jaw wink phenomenon is the traditional frontalis sling. 3 This procedure creates a link between the frontalis muscle and the tarsus of the upper eyelid, which allows for a better eyelid position in primary gaze. Eyelid elevation is then performed with the use of the frontalis muscle. 6-9
Several types of materials are currently available to create the sling between the frontalis muscle and the eyelid tarsus. These include autogenous or banked fascia lata and alloplastic materials that include chromic gut, collagen, polypropylene, silicone, stainless steel, silk, nylon monofilament, polyester, and polytetrafluoroethylene. 6 Fascia lata is not always a viable option in all patients because they need to be at least 3 years old to have adequate leg length to provide suitable fascia lata. 10
Two sling placement patterns have been developed for the frontalis sling method: single loop or double pentagon sling techniques. No difference in recurrence, function, or cosmetic result has been reported between these two commonly performed techniques. 6 In the conventional single loop design, two stab incision sites approximately 10 mm apart are marked 3...