Role of Orbital Septum and Sub Orbicularis Fibroadipose Tissue in Congenital Ptosis Surgery

Abstract

Purpose: To analyze the role of orbital septum and suborbicularis fibroadipose tissue in making and defining upper lid skin crease in children who underwent ptosis surgery.

Material and Methods: A retrospective study of 26 eyes of 22 children (age range 04 to 14 years) undergoing surgery over two year period was undertaken with regard to cosmetic outcome. A surgical technique by anterior approach employing orbital septum sutures during surgery in children is described. All surgery was performed by same ophthalmic surgeon under general anesthesia. A standard levator resection was undertaken, following which orbital septum and suborbicularis fibro adipose tissue was redefined and sutured with 6/0 vicryl.

Result: All patients achieved a well-defined lid crease postoperatively, with a good cosmetic outcome. The significant postoperative complications were stitch granuloma in two patients and mild residual ptosis occurred in five cases, requiring further procedure.

Conclusion: Special attention to the suturing of orbital septum and suborbicularis fibro adipose tissue as a separate tissue layer during levator resection in congenital ptosis gives good lid crease definition which may enhance the overall cosmetic outcome.