Correction of unilateral blepharoptosis with bilateral eyelid suspension.

Unilateral blepharoptosis with poor or no levator action can be corrected properly only by suspending the eyelid from the brow or frontalis muscle. This method lifts the eyelid adequately but often results in undesirable asymmetry, since the brow-frontalis lift on one side is so different from the levator lift on the other. Beard offered one solution. He cut the normal palpebral levator muscle and con­ verted the blepharoptosis into a bilateral con­ dition. He then suspended each eyelid with fascia lata to its respective frontalis. Both eyelids are then more symmetrical in all di­ rections of gaze. Not wishing to destroy the action of a normal levator muscle, and yet wishing to provide symmetry, I devised the following method: A Silastic* band is inserted in the blepharoptotic upper eyelid, and during the same operation a band is placed to act as a sling in the normal upper eyelid. With the slings adjusted properly, the frontalis mus­ cles will hold the eyelids up slightly while in repose, lift them evenly on looking up, and on looking down, the sling in the normal eye­ lid holds it at the same level as the blepharoptosed eyelid—thus, symmetry is achieved. Usually the fold in the normal eyelid is more pronounced postoperatively than preoperatively because of the lift provided by the Si­ lastic sling.