Abstract
Purpose
To assess the outcome of isolated Muller's muscle resection with preservation of conjunctiva in patients with blepharoptosis and good to moderate levator function.
Methods
This study was designed as a prospective, nonrandomised case series. Thirty-four eyes of 27 blepharoptosis patients were operated on, who were phenylephrine test-negative as well as positive. Open-sky Muller's muscle resection was performed with preservation of the conjunctiva. Main outcome measures were increase in margin reflex distance (MRD1), eyelid contour, and symptoms and signs of dry eye.
Results
The mean increase in MRD1 was 2.75 mm. All but one patient (96%) had upper lid margins resting at or up to 1 mm below the limbus and obtained symmetry to within 0.5 mm of the fellow eye. No patients had symptoms or signs of dry eye.
Conclusion
Isolated Muller's muscle resection is effective for the correction of ptosis in patients with moderate to good levator function. This is irrespective of the lid's response to phenylephrine. Preservation of conjunctival tissue eliminates concerns about dry eye, and also preserves the full height of the fornix.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Muller H . Uber glatte Muskeln an der Augenlidern des Menschen und der Saugetiere, IX. Verhandl PMG: Wurzberg, Germany, 1859, pp 244 (cited in: Whitnall SE, The Anatomy of the Human Orbit, 2nd edn. Oxford University Press: London, 1932).
Isaksson I . Studies on congenital genuine blepharoptosis. Acta Ophthalmol 1962; 72 (Suppl): 24.
Beard C . Muller's superior tarsal muscle; anatomy, physiology, and clinical significance. Ann Plast Surg 1985; 14: 324–333.
Putterman AM, Urist MJ . Muller muscle-conjunctiva resection for treatment of blepharoptosis. Arch Ophthalmol 1975; 93: 619–623.
Lake S, Mohammad-Ali FH, Khooshabeh R . Open sky Muller's muscle–conjunctiva resection for ptosis surgery. Eye 2003; 17 (9): 1008–1012.
Collin JRO . Ptosis repair of aponeurotic defects by the posterior approach. Br J Ophthalmol 1979; 63 (8): 586–590.
Baldwin HC, Bhagey J, Khooshabeh R . Open sky Müller's muscle-conjunctival resection in phenylephrine test-negative blepharoptosis patients. Ophthalmic Plast Reconstr Surg 2005; 21 (4): 276–280.
Dortzbach RK . Superior tarsal muscle resection to correct blepharoptosis. Ophthalmology 1979; 86 (10): 1883–1891.
Collin JRO, Beard C, Wood I . Experimental and clinical data on the insertion of the levator palpebrae superioris muscle. Am J Ophthalmol 1978; 85 (6): 792–801.
Berke RN, Wadsworth JAC . Histology of levator muscle in congenital and acquired ptosis. Arch Ophthalmol 1955; 53: 413.
Werb A . Ptosis. Aust J Ophthalmol 1976; 4: 40.
Bang YH, Park SH, Kim JH, Cho JH, Lee CJ, Roh TS . The role of Muller's muscle reconsidered. Plast Reconstr Surg 1998; 101 (5): 1200–1204.
Kiyoshi M . Stretching of the Muller muscle results in involuntary contraction of the levator muscle. Ophthalmic Plast Reconstr Surg 2002; 18 (1): 5–10.
McCully TJ, Kersten RC, Kulwin DR, Feuer WJ . Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis. Ophthalmic Plast Reconstr Surg 2003; 19 (5): 388–393.
Dresner SC . Further modifications of the Muller's muscle-conjunctival resection procedure for blepharoptosis. Ophthalmic Plast Reconstr Surg 1991; 7 (2): 114–122.
Daily RA, Saulny SM, Sullivan SA . Muller's muscle-conjunctival resection: effect on tear production. Ophthalmic Plast Reconstr Surg 2002; 18 (6): 421–425.
Putterman AM, Urist MJ . Muller muscle-conjunctiva resection ptosis procedure. Ophthalmic Surg 1978; 9: 27–32.
Shields M, Putterman A . Muller muscle–conjunctival resection: effect on tear production (Comment). Ophthalmic Plast Reconstr Surg 2003; 19: 254–255.
Karesh JW, Putterman AM, Fett DR . Conjunctiva–Müller's muscle excision to correct anophthalmic ptosis. Ophthalmology 1986; 93 (8): 1068–1071.
Author information
Authors and Affiliations
Corresponding author
Additional information
None of the authors have financial interest in any material used in this procedure.
Rights and permissions
About this article
Cite this article
Khooshabeh, R., Baldwin, H. Isolated Muller's muscle resection for the correction of blepharoptosis. Eye 22, 267–272 (2008). https://doi.org/10.1038/sj.eye.6702605
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6702605
Keywords
This article is cited by
-
A new algorithm for the transconjunctival correction of moderate to severe upper eyelid ptosis in adults
Scientific Reports (2024)
-
Comparison of clinical outcomes of conjunctivo-mullerectomy for varying degrees of ptosis
Scientific Reports (2023)
-
Minimally Invasive Conjoint Fascial Sheath Suspension for Blepharoptosis Correction
Aesthetic Plastic Surgery (2019)
-
Minimal incision posterior approach levator plication for aponeurotic ptosis
Eye (2015)
-
Open-sky isolated subtotal Muller’s muscle resection for ptosis surgery: a review of over 300 cases and assessment of long-term outcome
Eye (2013)


