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Unilateral Congenital Blepharoptosis Repair by Anterior Levator Advancement and Resection: An Educational Review

Background: Simple congenital blepharoptosis is caused by levator muscle dysgenesis and commonly presents unilaterally. A complete preoperative evaluation, including ophthalmic, neurologic, and levator function examinations, is essential for ensuring proper diagnosis and selecting the correct procedure. Correction is frequently delayed until the anatomical structures of the eye are fully developed and the child can cooperate with the preoperative examination between the ages of 3 and 5 years, except in cases of visual disturbances. After the preoperative evaluation, the proper treatment can be selected from commonly described procedures, including levator advancement, tarsomyectomy, and frontalis suspension. Methods: The authors provide a description of the pediatric levator advancement procedure and demonstrate the procedure with supplemental video content. Results: Levator advancement provides appropriate correction for moderate blepharoptosis repair in pediatric patients with fair to good levator function. Conclusions: Levator advancement in children presents unique challenges because of difficulty performing the preoperative examination and the inability of the patient to provide intraoperative cooperation for proper lid placement because of general anesthesia.