Tarsal Switch Levator Resection for the Treatment of Blepharoptosis in Patients with Poor Eye Protective Mechanisms

The authors report the use of a tarsal switch levator resection procedure that opens the palpebral fissure while reducing the risk of postoperative exposure in ptosis patients with poor eye protective mechanisms. Retrospective noncomparative case series. Fifteen consecutive patients of 2 surgeons at Texas Oculoplastic Consultants from July 1997 through July 2005. A composite tarsal-levator-conjunctival graft was taken from the upper eyelid and was transferred to the lower eyelid. Clinical assessment of postoperative exposure keratopathy and position of palpebral fissure relative to visual axis. A composite tarsal-levator-conjunctival graft was taken from the upper eyelid and was transferred to the lower eyelid in 26 eyelids of 15 patients. One patient was excluded because of lack of follow-up. There were 7 men and 7 women; the age ranged from 20 months to 74 years. The average duration of follow-up was 34 months, with a range of 3 to 85 months. The palpebral fissure was moved cephalad in all patients, improving their head position and unmasking their visual axis in primary gaze. One patient experienced exposure symptoms after surgery and required recession of the levator aponeurosis of both upper eyelids. Overall patient satisfaction was excellent. The tarsal switch levator resection procedure elevates both the upper and lower eyelids a predetermined amount. This displaces the palpebral fissure superiorly, effectively opening the visual axis in primary gaze and decreasing the risk of postoperative exposure problems in patients with diminished eye protective mechanisms.