Surgical adjustment of eyelid contour symmetry using three-point topography of the contralateral eyelid in unilateral congenital ptosis

Purpose To appraise the efficiency of three differential horizontal double-armed suture placements based on the topographic mapping of the contralateral normal eyelid in external levator aponeurosis surgery for unilateral congenital ptosis. Methods A Retrospective study, including unilateral congenital ptosis who underwent external levator aponeurosis surgery utilizing a differential suture placement technique, was performed. Preoperative demographics and clinical data were reviewed. Preoperative and postoperative photographs in the primary position were used for determining any asymmetry in upper and lower eyelid contour, MRD1 and MRD2 with respect to the normal contralateral eyelid, analysed by Fiji image J software. Results Eleven eyelids of 11 unilateral congenital ptosis patients with a mean age of 21.18 ± 1.33 years were enrolled in this study. Mean MRD1 Pre/Post levator surgery at 3-month follow-up was 0.512 ± 0.775/3.291 ± 0.982 mm (P = 0.00). The upper eyelid contour of the ptotic eyelid at 3-month post external levator aponeurosis surgery and contralateral eyelid were 0.93 ± 0.44/0.88 ± 0.41 (P = 0.533). There was no observed significant difference noted in MRD2 and lower eyelid contour (P = 0.092/P = 0.876) on comparison with the contralateral eyelid, following differential levator aponeurosis surgery at a 3-month follow-up visit. Conclusion The study emphasises the routine practice of contralateral eyelid threepoint topography measurement in unilateral congenital ptosis correction surgery to simplify the contour adjustment and obviate the need for frequent suture replacement.