Intra-orbital developmental arrest of the levator muscle in congenital ptosis with poor levator muscle excursion, A case report

Levator muscle dystrophy is the most approved etiology of simple congenital ptosis. Levator muscle excursion is the commonly used clinical test that determines the type of surgery. Poor levator muscle function has stigmatized the integrity of the levator muscle contractility for long and rationalized the decision of frontalis muscle-based surgical techniques. This is a case of bilateral moderate-to-severe congenital ptosis in an 11-month-old girl with poor levator excursion and high creases. Trans-crease sling surgery was decided. Dissection revealed an evident iris hue denoting the complete absence of levator aponeurosis being replaced by a septal layer covering the Muller-conjunctival complex. The edge of the aponeurosis appeared at the level of the orbital roof. The suturing of the muscle to the anterior surface of the tarsus achieved a good lid position and contour. This report points to the importance of levator muscle exploration even in the presence of poor muscle function to detect other levator muscle pathologies that may change the outcome.