Effect of shortening of levator palpebrae complex on combined fascial sheath suspension in severe blepharoptosis / 中华医学美学美容杂志

Objective:To explore the treatment of levator complex in conjoint fascial sheath suspension correction on severe ptosis, and to seek a reliable and less complications operation.Methods:From October 2016 to February 2020, 40 eyes of 24 patients with severe ptosis (6 males and 18 females, aged from 10 to 73 years, with an average of 34.4 years) were divided into study group and control group. 20 eyes in study group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction, while 20 eyes in control group were treated with combined fascia sheath suspension and levator palpebrae muscle complex tension-free shortening correction The effects and complications of the two groups were compared.Results:Follow-up studies were conducted at 1 week, 3 month and 6 months after operation. There was no significant difference between the two methods at different time points after operation, and the incidence of complications in the study group was less than that in the control group at 1 week after operation.Conclusions:Combined with fascial sheath suspension and levator palpebrae muscle complex tension-free shortening in the treatment of severe blepharoptosis has less complications and reliable curative effect in the early postoperative period, but it still needs to be improved to obtain more lasting curative effect.

Application of fat redistribution combined with shortening of upper eyelid levator muscle in repair of wide double-eyelid / 中华医学美学美容杂志

Objective To evaluate the clinical efficacy of topical fat redistribution in combination with shortening of upper eyelid levator muscle in patients with excessively wide palpebral fissure after double-eyelid operation.Methods Twenty patients with excessively wide palpebral fissure after undergoing double-eyelid operation were selected.The double-eyelid line was aesthetically re-designed,the skin or incisional scar between the original and new double-eyelid lines was excised,and the scarring adhesion among different tissues was fully isolated.The fat tissues within the orbital septum,deep orbit and anterior orbital septum combined with ROOF reconstruction were performed to block the adhesion tissues,shortening of levator muscle of the upper eyelid was equally conducted to enhance the cosmetic effect.Results Seventeen patients were satisfied with the cosmetic appearance following once double-eyelid operation.Two cases underwent twice operations due to different height between bilateral papebral fissures.One patient was unsatisfied with the cosmetic appearance.Conclusions Fat redistribution in combination with shortening of levator muscle of the upper eyelid can not only repair excessively wide palpebral fissure complicated with ptosis and upper eyelid depression,but also enhance the exposure rate of the cornea and increase the cosmetic appearance,which is consistent with contem porary aesthetic perception.

The clinical analysis of conjoint fascial sheath suspension on the treatment of severe blepharoptosis after levator muscle resection / 中华整形外科杂志

Objective@#To evaluate the safety and efficacy of Conjoint Fascial Sheath (CFS) suspension in the treatment of severe blepharoptosis, after levator muscle resection.@*Methods@#In total of 336 patients with severe blepharoptosis after levator muscle resection, received CFS suspension from December 2010 to December 2016 in Beijing Lomeye Cosmetic Surgery Clinic. They were followed up for 12—60 months.The margin reflex distance, curve of upper eyelid, appearance and complications were recorded preoperatively and postoperatively. The outcome was evaluated based on function, aesthetics and complication.@*Result@#Functional satisfaction assessment: In the 495 eyes of 336 patients, 426 eyes (86.1%) were completely corrected, 65 eyes (9.1%) were improved, while 4 eyes (0.8%) had no improvement. One patients had conjunctival edema, recovered after conservative treatment. There was no serious complication.@*Conclusions@#CFS suspension is an effective method for severe blepharoptosis after levator muscle resection, with advantages of repeatability and feasibility, less trauma and predictable outcome.

Effectiveness of levator muscle resection combined with Mustarde's double Z-plasty for blepharophimosis-ptosis-epicanthus inversus syndrome / 中国修复重建外科杂志

Objective: To investigate the effectiveness of levator muscle resection combined with Mustarde's double Z-plasty to correct blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Methods: Between March 2015 and June 2017, one-stage operation of levator muscle resection combined with Mustarde's double Z-plasty were performed on 26 children with bilateral BPES. There were 16 boys and 10 girls with an average age of 7 years (range, 4-14 years). All patients marked the four typical signs of BPES. There were 7 cases accompanied with a low nasal bridge, and 20 cases with amblyopia and strabismus. The length of eye fissure was (19.5±4.5) mm, the width of eye fissure was (2.5±1.6) mm, the diameter of inner canthus was (42.1±6.5) mm, and the muscular strength of levator palpebrae superioris was (5.5±1.3) mm. Results: All the incisions healed by first intention. Twenty-three patients were followed up 2-12 months, with an average of 10 months. Among which, 2 cases were less corrected, 3 cases were over corrected, 6 cases had poor curvature of the eyelid. No eyelid internal and external pronation or keratitis occurred. Amelioration of blepharoptosis and epicanthus was achieved in the other patients, and the double eyelid fold was naturally smooth. At 7 days after operation, the length of eye fissure was (27.2±1.9) mm, the width of eye fissure was (12.5±1.3) mm, and diameter of inner canthus was (29.4±2.6) mm, which were superior to preoperative values ( t=0.127, P=0.042; t=0.341, P=0.029; t=0.258, P=0.038). There was no angular deformity caused by the width and length regressions of eye fissures. Conclusion: The levator muscle resection combined with Mustarde's double Z-plasty can effectively correct BPES and obtain good effectiveness.

Clinical effect of combined fascial sheath suspension with upper blepharoplasty to treat congenital ptosis in Uygur population / 中华医学美学美容杂志

Objective To investigate the clinical effect of combined fascial sheath suspension with upper blepharoplasty to treat congenital ptosis in Uygur population.Methods 42 patients with congenital ptosis (63 eyes) were selected during December 2015 to September 2017 in the People's Hospital of Xinjiang Uygur Autonomous Region.Combined fascia sheath suspension with levator leva tor shortening was used for the treatment.The postoperative correction effect was observed and the patients were followed up for the complications and satisfaction.Results The moderate and severe ptosis was improved and the effective rate was 95.0％,and so the surgical treatment was effective.The incidence of adverse reactions and the recurrence rate of the disease were significantly lower than those of other procedures.Conclusions CFS plus LM treatment for severe ptosis has obvious surgical results in Uygur population,and the satisfactory rate is higher than moderate patients.In addition,the incidence of orbital regurgitation in moderate patients is lower than that in severe patients.

Clinical study on conjoint fascial sheath suspension in the treatment of moderate and severe ptosis / 局解手术学杂志

Objective To investigate whether the conjoint combined with fascial sheath( CFS) suspension can be used as an effective method for correction of moderate and severe ptosis. Methods Thirty-five patients (39 eyes) with moderate or severe ptosis were treated in our hospital from January 2014 to March 2017 by means of CFS suspension,frontalis suspension and shortening of levator palpebrae superior-is,and all the patients were followed up for 3～12 months. Results The CFS suspension and the other two operations appeared effective;and compared with the other two methods,the difference was statistically significant(P<0. 05). The CFS suspension for the treatment of moderate and severe ptosis with a higher positive rate(95％) and the positive rate of the other two methods was 67％. In terms of complications,the CFS suspension showed eyelid dysraphism incidence rate was exposure keratitis occurred in 85. 7％ and entropion occurrence rate of 4. 7％;with the other two methods,the surgical eyelid dysraphism occurred in 100％ and the conjunctival prolapse occurred in 5. 6％. Conclusion The CFS suspension in correction of moderate and severe ptosis has the advantages of less trauma,less complications and good correction effect.

The levator muscle combined with Müller′s muscle shortening for treatment of mild and moderate congenital blepharoptosis / 中华整形外科杂志

Objective@#To investigate the therapeutic effect of levator muscle combined with Müller′s muscle shortening for treatment of mild and moderate congenital blepharoptosis.@*Methods@#Thirty-one cases (38 eyes) with mild or moderate congenital blepharoptosis were treated through both skin and conjunctiva approach. The levator muscle was exposed through skin approach. The Müller′s muscle was separated from conjunctiva through conjunctiva approach. The combined flap of levator muscle and Müller′s muscle was freed from the upper edge of tarsus and shortened. Then the combined flap was fixed on the upper 2/3 portion of tarsus to correct the ptosis.@*Results@#All the patients were followed up for 6-24 months with satisfactory result . The result was graded as good 12 eyes, generally 21 eyes, inadequate correction 3 eyes, over-correction 1 eye, and nvalid correction 1 eye. The effective rate was 86.8%.@*Conclusions@#The levator muscle combined with Müller′s muscle shortening is a very simple and practicle method for mild to moderate congenital blepharoptosis with satisfactory result.

Physiological strategy for treatment of mild and moderate upper eyelid with ptosis / 中华医学美学美容杂志

Objective Patients with mild or moderate blepharoptosis performed with double eyelid operation only will lead to high complication rates,such as eyelid crease disappearance,unphysiological appearance.In such cases,utilizing levator aponeurosis can create more physiological double eyelid and correct blepharoptosis in the meantime.Methods Levator aponeurosis is utilized as "connecting tissue" to transmit dynamic "motor power" of levator muscle to upper eyelid.Levator advancement was performed at the same time to correct blepharoptosis.Results A total of 74 patients (125 eyes) were operated on in this study.117 eyes (93.6％) showed adequate blepharoptosis correction results,8 eyes (6.4％) showed inadequate correction results.Sixty six cases (89.2％) showed good symmetry results,5 cases (6.8％) showed fair results,3 cases (4％) showed bad symmetry results.One hundred and fourteen eyes (91.2％) showed stable crease,11 eyes (8.8％) showed fair results,no disappearance result was observed in this study.No scar hypertrophy or blepharoptosis on the upper eyelid was encountered.Conclusions This new technique uses pretarsal levator aponeurosis to connect levator muscle and upper eyelid skin,it transmits the dynamic power of the levator muscle to the lid skin directly,which created palperbral crease more anatomically and physiologically.In the meantime,levator advancement can be performed to correct blepharoptosis.Furthermore,"skin adhesion" is formed between levator aponeurosis and dermis in a plane planar manner,allowing for more stable palperbralpalpebral crease and more preserved,and preserving orbicularis oculi in situ,leaving no gap in skin and thus reducing eyelid scar formation.

A new technique of modified levator muscle prolongation treatment of iatrogenic upper eyelid retraction / 中华医学美学美容杂志

Objective To evaluate the effect of correcting upper eyelid retraction in patients with iatrogenic ophthalmopathy by a new technique of modified transsection and longitudinal suture levator muscle prolongation treatment.Methods The traditional levator muscle flap trapezoidal incision was changed into horizontal incision,According to the amount of upper eyelid retraction we designed a transverse incision with 1 ∶ 2 in the central part of levator aponeurosis.Along the line of incision was designed transverse incision of Mulller's muscle combined with levator aponeurosis complex was designed,with longitudinal suture of incision.Results Five patients (6 eyes) with iatrogenic upper eyelid retraction were treated by this method.The follow up was performed for 3 to 12 months.All were satisfied with good cosmetic results,the degree of bilateral corneal exposure was symmetrical,with no recurrence and complications,except for 1 cases of unilateral upper eyelid retraction width slightly asymmetry.Conclusions The application of modified levator muscle prolongation treatment is not only quite simple,easy to adjust in operation,but also with reliable effect and less complication.It is effective for iatrogenic upper eyelid retraction range from mild to moderate degrees of correction.

Clinical efficacy of conjoint fascial sheath of the levator and superior rectus attached to conjunctival fornix suspension surgery in treatment of severe blepharoptosis / 中华医学美学美容杂志

Objective To investigate the clinical efficacy of conjoint fascial sheath (CFS) of the levator and superior rectus attached to the conjunctival fornix suspension surgery and the modified frontails muscle suspension in the treatment of severe blepharoptosis.Methods There were 15 eyes of 11 patients in the group with CFS suspension and 12 eyes of 10 patients in the other group with frontails muscle suspension.Follow-up was conducted for 1 week to 6 months.The surgical results were compared with statistical analysis.Results Among the patients 2 cases of palpebral fissure was closed poorly,1 cases of upper eyelid had poor shape,4 cases of upper lid was lag,2 cases of recurrence in group with modified frontails muscle suspension,and compared with 1 case of less straightening phenomenon in the group with CFS suspension.All the others,palpebral fissures were completely closed,the appearance of double eyelid was good,with no exposure keratitis.In terms of postoperative curative effect in 6 months observation,group with CFS suspension had less complications and was of advantages in the symmetry of upper eyelid fissure.The effect of correction post operation and upper eyelid back amount in the group with CFS suspension were better than those with the frontails muscle suspension in 6 months.There was significantly statistical difference.Conclusions The surgery with CFS suspension is of advantages of aesthetic appearance,high security,natural look,high satisfaction from patients,less complications and more in line with the physiology,which is worthy of clinical reference.

Comparative study on conjoint fascial sheath suspension and levator muscle resection for moderate or severe congenital ptosis / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To compare the curative effect of conjoint fascial sheath( CSF) suspension and levator muscle resection for moderate or severe congenital ptosis.?METHODS: Forty - three patients ( 74 eyes ) with moderate or severe ptosis were treated by CSF suspension or levator muscle resection randomly, and followed up for 6mo. The normalization rates of the two operations were then compared by statistical method, and the complications of the two operations were analyzed.?RESULTS: The two operations appeared no significant difference on the normalization rate for moderate congenital ptosis (P>0. 05), while the normalization rate of CSF suspension on severe congenital ptosis was significantly higher than that of levator muscle resection (P<0. 05). Less complication was happened in the CSF suspension group than in the levator muscle resection group.?CONCLUSION:CSF suspension is more effective on the treatment of severe congenital ptosis than levator muscle resection, and has advantages such as less trauma, repeatable, and less complication.

Effect on the treatment of congenital ptosis in two kinds of operation method / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To compare the functional and cosmetic effects of two different surgical techniques for congenital ptosis. METHODS: The patients were divided into four groups according to the operation method: Patients undertook bilateral fascial suspension surgery as Group A ( 42 eyes of 21 cases ); Patients undertook bilateral levator muscle shortening surgery as Group B ( 38 eyes of 19 cases );Patients undertook unilateral fascial suspension surgery as Group C ( 24 eyes of 24 cases ); Patients undertook unilateral levator muscle shortening surgery as Group D (29 eyes of 29 cases). Each group patients were followed for postoperative function and appearance effect. RESULTS: 1 ) Early postoperative of two operation function success rate was up to 100%, the function of levator muscle shortening surgery was 97. 01% in the late postoperative, was higher than bilateral fascial suspension surgery (87. 88%), with statistical difference in both surgerys (P0. 05); ln the late postoperative, the mean grades for “Lid Contour” and “Lid Crease” of Group B were better than that of Group A (P CONCLUSlON: Two kinds of operation method have good effects on the treatment of congenital ptosis. ln terms of cosmetic effect, levator muscle shortening surgery is better.

Tratamento de ptose palpebral congênita pela técnica de Lester Jones / Treatment of congenital ptosis by using the Lester Jones technique

A ptose palpebral ou blefaroptose caracteriza-se pela disfunção, ou inabilidade do paciente em realizar a abertura da fenda palpebral de maneira normal. Geralmente é decorrente do acometimento do músculo levantador da pálpebra; a forma congênita ocorre em 60% a 70%. No presente trabalho é descrito um caso de ptose palpebral congênita moderada em uma paciente de nove anos, com boa função do músculo levantador da pálpebra, em olho esquerdo. A paciente foi submetida a tratamento cirúrgico pela técnica de Lester Jones, indicada nos casos de ptose de grau moderado, apresentando um resultado estético e funcional satisfatório.

Palpebral ptosis or blepharoptosis is characterized by the dysfunction or inability of the patient to normally open the palpebral fissure. Usually, it is due to the involvement of the eyelid levator muscle. The congenital form occurs in 60%-70% of cases. In this study, we describe a case of moderate congenital palpebral ptosis in a 9-year-old patient who presented with a good eyelid levator muscle function in the left eye. The patient underwent surgical treatment with the Lester Jones technique, as indicated for cases of moderate ptosis, and achieved satisfactory aesthetic and functional results.

Three methods of surgical treatment for upper eyelid retraction / 局解手术学杂志

objective To explore a reasonable treatment for upper eyelid shrinking. Methods All 15 patients with upper eyelid retrac-tion were divided in group A,group B and group C. Group A with 9 eyes received botulinum toxin type A,group B with 10 eyes were corrected by central aponeurosis disinsertion,group C with 9 eyes upper eyelid were corrected by the lengthening of the levator muscle and Müller's muscle. And the data was summarized and analyzed. Results Five cases (9 eyes) with upper eyelid shrinking obviously were improved 72 h after injecting botulinum toxin type A,but the eyelids returned to previous states 4~6 months later. The shape of postoperative eyelid was good and the eyelids structure was natural in group B,recurrence was in 2 cases. Patients in group C had satisfactory results. And there was no recurrence and complications after 3~24 months of follow-up. Conclusion The three treatments have effect on upper eyelid shrinking at quiescence phase. The method of injecting botulinum toxin type A is simple,with reliable curative effect and short duration,while it was nee-ded repeated injections. The method of central aponeurosis disinsertion is simple but difficult to quantify properly. The lengthening of the leva-tor muscle is not only simple but also with reliable effect and less complications.

Unilateral Ptosis Due to Isolated Levator Myositis

PURPOSE: To present a rare case of idiopathic orbital myositis involving levator palpebrae superioris. CASE SUMMARY: A 27-year-old male presented with a 1-week history of redness, discomfort, swelling, and drooping of his left upper eyelid. A computed tomography scan showed isolated enlargement of the right superior rectus/levator muscle complex. On examination, there was a left blepharoptosis, although eye movements were normal. The authors treated the patient with 3rd-generation cephalosporin; however, after 3 days, the symptoms did not improve. Subsequently, the patient was diagnosed with idiopathic orbital myositis and treated with oral corticosteroids for 1 month; the symptoms gradually resolved. CONCLUSIONS: Idiopathic orbital myositis is a subtype of nonspecific orbital inflammation primarily involving the extraocular muscles. Although the exact cause of orbital myositis is unknown, an immune-mediated pathophysiologic mechanism appears to be one of the causes. Medial rectus myositis is the most common, and isolated levator muscle myositis is very rare. The authors of the present study reported a case of orbital myositis involving the levator palpebrae superioris which should be considered a differential diagnosis of blepharoptosis with eyelid swelling.

Use of the Levator Muscle as a Frontalis Sling in Monocular Elevation Deficiency

PURPOSE: For the correction of ptosis in monocular elevation deficiency (MED) patients, levator resection or frontalis sling operation with various materials has been used. The authors present a case of a monocular elevation deficiency patient who was treated for ptosis using the levator muscle as a frontalis sling. CASE SUMMARY: A six-year-old male patient with left monocular elevation deficiency underwent a frontalis sling operation using a levator muscle. The patient had received left inferior rectus recession, left medial rectus resection and left lateral rectus recession with transposition. An upper eyelid skin crease incision was made, and the anterior surface of the levator muscle was exposed as far as the Whitnall ligament. A levator muscle flap was then formed from aponeurosis by incising the full width of the levator horizontally, just below the Whitnall ligament and anchored to the frontalis muscle. The surgical result was satisfactory as the preoperative MRD1 was 0.5 mm and the postoperative MRD1 was 2.5 mm. There were no complications such as keratitis or wound problems. CONCLUSIONS: The levator muscle flap can be an effective frontalis suspension material to correct ptosis in an MED patient with poor levator function.

Protocolo de manejo quirúrgico de la ptosis palpebral congénita. Hospital del niño Dr. Francisco de Ycaza Bustamante, junio–julio 2004 / Protocol of Surgery in a Congenital palpebral ptosis: Children Hospital Dr. Francisco de Ycaza Bustamante, June-July 2004

Tipo de estudio: prospectivo, descriptivo-analítico, longitudinal, en una serie de casos compuesta por 45 pacientes (57 ojos) portadores de ptosis palpebral congénita que asistieron a la consulta de los servicios de Cirugía Plástica y Oftalmología del hospital del niño “Dr. Francisco de Ycaza Bustamante”, en el período comprendido entre junio y julio de 2004. Objetivo: establecer un protocolo quirúrgico de acuerdo al estado clínico de la ptosis, que determine los procedimientos ideales para su correcto tratamiento. Metodología: durante el estudio evaluamos la severidad de la deformidad, las técnicas empleadas para su corrección, los resultados obtenidos y determinamos las complicaciones posquirúrgicas. Resultados: dentro de los resultados se apreció que el grado severo cursó con una función nula del músculo en 32 ojos (66,6%); la función regular predominó en las ptosis moderadas con 3 ojos (60%) y 2 ojos (40%) para ptosis severa, con un total de 5 ojos (10,41%); mientras que la función buena, prevaleció en las ptosis leves con 5 ojos (55,5%) y 4 ojos (44,4%) para ptosis moderada, dando un total de 9 ojos (18,75%); mientras que la función excelente predominó en las ptosis leves con 2 ojos (4,16%). En 31 ojos empleamos suspensión frontal con fascia (63,26%), en 7 ojos acortamiento del elevador (14,28%), en 5 ojos técnica de Fasanella Servat. Conclusión: podemos establecer que la ptosis palpebral es una enfermedad importante y relativamente frecuente en nuestra sociedad, que requiere el establecimiento de un protocolo quirúrgico que guíe su adecuada corrección.

Type os Study: Prospective, Descriptive-analytic, longitudinal, in a series of cases in 45 patients (57 eyes) carriers of congenital palpebral ptosis that attended in the Plastic Surgery and Ophthalmology service of Children Hospital “Dr. Franciso Icaza Bustmante”, in the period between June and July 2004. Objectives: The present study have like a objective, establish a surgery protocol depending of ptosis stage, that determine the best method for treatment. Methodology: During the study, evaluated the severity of deformity, the technical applied for correction, results obtained and determined the post surgical complications. Results: Several grade had a useless function of muscle in 32 eyes (66,6%); regular function predominated in moderate ptosis with 3 eyes (60%) y 2 eyes (40%) for several ptosis, with 5 eyes total (10,41%); while the good function, prevailed in mild ptosis with 5 eyes (55,5%) and 4 eyes (44,4%) for moderate ptosis, with 9 eyes total (18,75%); while a excellent function predominated in mild ptosis with 2 eyes (4,16%). In 31 eyes applicated frontal suspension with fascia (63,26%), in 7 eyes shortness of levator (14,28%), in 5 eyes Fasanella Servat technic. Conclusion: Palpepral ptosis is a important illness in our society, require to establish a protocol that guidance of this specialties

Management of the upper eyelid retraction by severing of the Levator & Muller Muscle in upper eyelid / 나학회지

The surgical treatment of long duration lagaphthalmos was traditionally conducted using the Gillies (1934) method of temporal muscle transfer. This method has been effective in cases of simultaneous lagaphthalmos in the upper eyelid and ectropion in the lower eyelid. In the past, we treated 18 leprosy patients who suffered complications of ptosis in the upper eyelid and ectropion in the lower eyelid after the application of the Gillies method. To treat these complications, we removed the fascia strips emplaced during temporal muscle transfer from the upper and lower eyelid. Thereafter, we implanted a 1.0 gram gold plate in the upper eyelid and either a conchal cartilage graft. In the treatment of Lagaphthalmos over the past seven years, we have applied gold plate lid loading in 120 cases. However, in five of these cases, patients suffered from exposure of the gold plate due to paralytic orbicularis oculi muscle tearing. Recently, to correct this, we covered the gold plate with AlloDerm tissue to protect and support the muscle. In the treatment of ectropion over the last six years, we have had over 30 cases of cartilage grafts (over 35mm in length and 5mm in breadth) in the lower eyelid. However, the end of the cartilage graft would warp and create new partial ectropion several months later. Because of this, we shifted from cartilage to AlloDerm. We applied 40mm (length) and 7mm (breadth) to the lower border of the tarsus and fixed at each end with medial and canthal ligament. From 1997 to 2002, in the Institute of Leprosy Research, we operated on 25 patients suffering from Lagaphthalmos and Ectropion using a newer treatment to correct ectropion more effectively. The levator muscle of the upper eyelid loses the funtion of its antagonistic muscle, namely the orbicularis oculi due to facial nerve palsy, and results in retraction of the upper eyelid. To correct upper eyelid retraction, we severed the levator and muller muscle from the superior tarsal border and discontinued the use of gold lid loading which is visually evident. This method does not result in ptosis and the eye is more normal in appearance.

The Surgical Treatment of Ptosis with Marcus-Gunn(Jaw-Winking) Phenomenon

The authors operated 7 cases with severe ptosis and moderate to severe jaw-winking phenomenon, with the extirpation of the levator muscle above Whitnall's ligament on affected eye and the bilateral frontalis suspension with preserved fascia lata. Seven patients observed for up to 22.5 months have had cosmetically and functionally desirable results with disappearance of jaw-winking phenomenon.

Clinical Evaluation of Ptosis after Peribulbar Anesthesia

We evaluated ten ptotic eyes of two hundred thirty eight eyes which had a peri bulbar anesthesia in aspects of sex, age and type of operation. Also we clinically evaluated the degree of ptosis, the function of levator muscle and postoperative interval to recovery of ptosis. The results were as follows: 1. Ptosis developed in 10 eyes (4.2%). Sex distribution was 8 females (80.0%) and 2 males (20.0%), and age distribution was from 44 to 83 years old. 2. At the postoperative 1 day, the most common degree of ptosis was severe form (60.0%), followed by mild form (30.0%) and moderate form (10.0%). In the function of levator muscle, 5 eyes (60.0%) were fair, followed by poor (30.0%) and good (20.0%). 3. The postopertive interval to recovery of ptosis was from 2 to 60 days, and then 5 eyes (50.0%) were Group II, followed by Group I (30.0%) and Group Ill (20.0%).