Frontalis Muscle Flap Repair for Conjunctival Prolapse With Tarsal Plate Eversion After Severe Congenital Ptosis Surgery

OBJECTIVE: To evaluate the efficacy of frontalis muscle flap surgery in repairing conjunctival prolapse with tarsal plate eversion following severe congenital ptosis correction. METHODS: A retrospective analysis was conducted of patients who underwent correction of congenital ptosis at our institution between January 2014 and December 2023. Patients meeting the inclusion criteria for conjunctival prolapse with tarsal plate eversion were reviewed, and frontalis muscle flap surgery was performed for correction. RESULTS: Among 1472 patients with congenital ptosis, 740 had severe cases, and 6 developed postoperative conjunctival prolapse with tarsal plate eversion. Five cases were unilateral, and 1 was bilateral, involving 3 boys and 3 girls. All patients initially underwent levator advancement with tendon shortening, and conjunctival prolapse developed between postoperative days 2 and 7. Following correction using frontalis muscle flap surgery, the prolapsed conjunctiva was successfully repositioned, and ideal upper eyelid height was maintained at the 3-year follow-up. All patients were satisfied with the outcomes. CONCLUSION: Frontalis muscle flap surgery effectively corrects conjunctival prolapse with tarsal plate eversion after congenital ptosis repair. The technique avoids excision of the conjunctiva and tarsus, maintains eyelid height, and achieves good cosmetic and functional results.