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ABSTRACT
Müllers muscle is a sympathetically innervated muscle that can be resected to treat upper eyelid ptosis.
Candidates for the ptosis procedure are those whose upper lids elevate to a normal level following instillation of phenylephrine hydrochloride drops into their upper ocular fornix. A specially designed clamp is applied to 6.5 to 9.5 mm of conjunctiva and Müller's muscle above the superior tarsal border. A suture is run distal to the clamp, connecting conjunctiva and Müller's muscle to the superior tarsal border; then, the tissues held in the clamp are resected. In a ten-year study of this procedure, 90% of the lids with acquired ptosis and 100% of those with congenital ptosis were within 1.5 mm of the level of the opposite lid postoperatively. Only two of 232 treated lids required additional surgery.
In 1859, Müller described the anatomy of a sympathetically innervated muscle in the upper eyelid. It has since been referred to by his name.1
In 1975, Putterman and Urist described a technique in which Müllers muscle is partially resected and advanced.2 The Müllers muscle-conjunctival resection ptosis procedure is recommended for patients with blepharoptosis whose upper eyelids elevate to a normal level when 10% phenylephrine drops are applied to their upper ocular fornix. Candidates usually have minimal congenital ptosis and varying degrees of acquired ptosis.
The purposes of this paper are to report the results of this procedure over the past ten years and to describe the technique with recent modifications.
ANATOMY
Müller's muscle in the upper eyelid originates from the levator aponeurosis, approximately 15 mm above the superior tarsal border (Figure 1), and it inserts onto the superior tarsal border. Müller's muscle spans the horizontal dimension of the eyelid and is firmly attached to conjunctiva on its posterior surface and loosely attached to the levator aponeurosis on its anterior surface. Müllers muscle resembles other smooth muscular tissue and is approximately 1 mm thick.
MARGIN REFLEX DISTANCE ONE
Before performing the phenylephrine test, it is important to assess the upper eyelid levels with the margin reflex distance one (MRD1) measurement (Figure 2). The surgeon holds a muscle light at eye level and shines it on the eyes of the patient. The distance from the corneal light reflex to the central upper...