Surgery for Blepharoptosis in Muscular Dystrophy
Ori Mahler, Asher Milstein, Ayala Pollack, Daniel Hauben
Eye Dept., Kaplan Medical Center, Rehovot; and Plastic Surgery Dept., Rabin Medical Center, Petah Tikva
In some muscular dystrophies there is ocular involvement characterized by blepharoptosis and ophthalmoplegia. These conditions occur in chronic progressive external ophthalmoplegia, oculopharyngeal muscular dystrophy, mitochondrial myopathy, myotonic dystrophy, and ocular myasthenia, among others. Although they differ in their systemic clinical manifestations and in genetic inheritance, ocular involvement is common to all of them. Manifestations include bilateral progressive blepharoptosis with or without extraocular muscle malfunction.
During surgical repair of the ptotic eyelid, consideration must be given to eyeball movements, in addition to maximal eyelid elevation, and to avoiding overcorrection and consequent corneal overexposure, leading to dryness and visual impairment. With these muscular dystrophic disorders, resection of the levator muscle or blepharoplasty alone does not suffice. Follow-up shows that most patients need a secondary repair after a short while. Operative correction uses a frontalis sling for eyelid elevation and support.
A series of 8 patients with these diseases, operated on by various surgical techniques during the past 7 years, is presented.