Pediatric Sutureless Conjunctiva-Sparing Versus Traditional Müllerectomy: A Comparative Study

Purpose: To compare sutureless conjunctiva-sparing Müllerectomy (CSM) versus Müller muscle–conjunctival resection (MMCR) in pediatric ptosis repair. Methods: This is a retrospective comparative study of pediatric patients with mild ptosis and near-normal levator function who underwent either sutureless CSM or MMCR at a single academic institution. Children aged below 18 years with unilateral or bilateral ptosis and levator function ≥10 mm were enrolled in this study. Patients with prior ptosis repair were excluded. Primary outcomes were change in margin–reflex distance 1 (ΔMRD1) and postoperative symmetry; secondary outcomes included operative time, postoperative complications, and reoperation. Results: Thirty-three operative eyelids met the inclusion criteria: 13 underwent sutureless CSM, and 20 underwent traditional Müllerectomy. Age at surgery, preoperative MRD1, and levator function did not significantly differ between cohorts. Both cohorts were predominantly comprised of patients with congenital myogenic ptosis. Mean ΔMRD1 was 1.2 mm in the sutureless CSM group versus 1.3 mm in the MMCR group ( P =0.56), and symmetry at last follow-up was 0.7 mm versus 0.8 mm ( P =0.74). Operative time was significantly shorter for sutureless CSM (7.5 versus 13.5 min per eyelid; P =0.001). Reoperation rates (33% versus 18%; P =0.35) and complication incidence (none in both groups) were comparable. Conclusions: Sutureless CSM achieves similar eyelid elevation and symmetry to MMCR while reducing operative time, supporting its adoption as a safe and efficient alternative in pediatric ptosis repair.