Simple rules for orientation in transcutaneous ptosis surgery--a contribution to the surgical anatomy or: how not to get lost in the upper eyelid

• Published in: Klinische Monatsblatter fur Augenheilkunde Vol. 229; no. 1; p. 31
• Main Authors: Schaudig, U, Schumacher, S
• Format: Journal Article
• Language: German
• Published: Germany 01-01-2012
• Subjects: Algorithms; Blepharoplasty - methods; Blepharoptosis - pathology; Blepharoptosis - surgery; Humans
• ISSN: 1439-3999
• DOI: 10.1055/s-0031-1282049

Surgical preparation in the upper eyelid follows well defined anatomic structures. Nevertheless, even an experienced surgeon can loose orientation in the presence of fatty degeneration, oedema or bleeding. Some simple rules can help to stay oriented and identify the landmarks. The preaponeurotic fat has a distinct colour, structure and texture and is a landmark for the levator muscle lying underneath it. This defines a first simple rule: it is not preaponeurotic fat if it does not look like preaponeurotic fat. The orbital septum may weaken and allow orbital fat to prolapse, but it stays firmly attached at the upper orbital rim. A second simple rule therefore adresses its identification: if a structure does not move with inferior tension, it cannot be muscle or fat (it must be septum). Identifying the landmarks preaponeurotic fat, orbital septum and tarsus will facilitate anatomic correlation and surgical preparation. In summary: Rule No. 1--If it does not look like preaponeurotic fat, then it isn't. Rule No. 2--If it does not move with traction, it is neither muscle nor fat (but probably septum). Rule No. 3--If things get confusing, stop and consider rules 1 and 2.