This article is part of Ophthalmology Advisor’s conference coverage from the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery, held in New Orleans from November 11 to 12, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the oculoplastic researchers and other clinicians at the ASOPRS. Check back for more from the ASOPRS 2021 Fall Scientific Symposium.

In pediatric patients with blepharoptosis, there is an increased risk of vision obstruction that can lead to abnormal visual development. When there is concern about the potential for development of amblyopia, surgical correction is indicated. One of several currently used repair techniques is Müller’s muscle conjunctival resection (MMCR), with or without tarsectomy. MMCR has proven to be safe and effective in the pediatric population. However, cosmetic and functional outcomes of MMCR with tarsectomy have not been fully characterized with respect to lid position and crease height. 

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In a poster presentation at the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), investigators from Baylor College of Medicine, Houston, reported outcomes of a study to evaluate cosmetic and functional outcomes related to effects of MMCR with tarsectomy on the eyelid. They compared postoperative photos of pediatric patients who underwent MMCR with or without tarsectomy, focusing on postoperative lid crease height.

Retrospective chart reviews were performed by ASORPS-trained oculoplastic surgeons on all patients who underwent MMCR surgery with or without tarsectomy at a tertiary referral center from 2017 to 2021. A total of 10 pediatric patients (6 girls) were assessed and included in the analysis. All were diagnosed with unilateral or bilateral congenital ptosis. The mean age for patients treated with MMCR alone was 12.46 years, and the mean age for patients treated with MMCR plus tarsectomy was 10.65 years. 

All patients underwent a 9 mm MMCR with (n=6) or without (n=4) tarsectomy of 1 or 2 millimeters. Photograph analysis with ImageJ software was used to measure preoperative vs postoperative marginal reflex distance 1 (MRD1), palpebral fissure height, and lid crease height.  

The investigators found that in patients with congenital ptosis, there was a general trend towards decreased lid height when MMCR was performed with tarsectomy. Functional results as measured by MRD1 measurements, however, showed no statistically significant difference between patients who did vs did not undergo tarsectomy (P =.92). 

Presenters advised that “potential changes in lid crease height should be noted in preoperative counseling and postoperative assessment of lid height and contour.” 

Visit Ophthalmology Advisor’s conference section for complete coverage of the ASOPRS 2021 Fall Scientific Symposium.



Pecha J, Williams K, Allen R. Effect of tarsectomy on post-operative lid position and crease height in patients with congenital ptosis undergoing Müller’s muscle conjunctival resection. Poster presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium; November 11-12, 2021; New Orleans.