Levator surgery and histology in congenital and senile ptosis

Analysis of the levator operations between 1978 and 1983 in the University Eye Hospital Kiel demonstrates that transconjunctival levator operations are more and more abandoned in favour of the transcutaneous approach. The advantages and disadvantages of both methods are discussed. The transcutaneous approach offers a better view together with a more individually adapted dosage and modification of the technique. Histology confirms that in congenital ptosis the degenerations and atrophy are present mainly in the muscular part of the levator while in acquired ptosis the pathology can be found in the aponeurosis. Here the therapy should be aimed at this latter part of the muscle. Proper estimation of the dosage of resection is a must for the avoidance of complications. If possible the Whitnall ligament should be left intact.