Operative Treatment of Congenital Ptosis *

As Berke has pointed out, however, more than eighty operations have been described, although all are modifications of one or other of the above procedures. This multiplicity of methods is proof in itself that surgeons, in general, do not obtain conisistently good results from any one operation. Since Dransart (1880) first suggested the insertion of subcutaneous sutures of catgut to try to create a band of cicatricial tissue between the frontalis and the up5per lid, many similar procedures have been described, but to-day the most frequent method of utilizing the frontalis is undoubtedly by the insertion of strips of fascia lata, as suggested by Wright (1922) and recommended by Lexer (1923) and other authors. This operation is widely used and is an effective method of correcting many cases of ptosis. It has, however, the undoubted disadvantage that the cosmetic result is often not satisfactory, which is hardly surprising in view of the fact that the pull is vertically upwards with consequent loss of the normal curvature of the upper lid. Even the insertion of extra stitches to join the fascia to the skin, as suggested by Juler (1939), does not achieve a good cosmetic result in most cases. It is of interest to note that Juler himself, although mentioning the latter procedure, expressed a preference for the method of Blaskovics (1929), namely advancement and resection of the levator, to that described by Wright and by Lexer. The use of the superior rectus (as originally suggested by Parinaud (1897) and Motais (1897), with modifications introduced by later workers) while it produces, when successfully performed, a good cosmetic result, is not without grave disadvantages. A certain degree of lagophthalmos is unavoidable since the eyeball cannot roll upwards during sleep and there is consequent danger of exposure keratitis in cases where ptosis is fully corrected by this method. It is also difficult to avoid undue arching of the lid margin, and