Management of congenital blepharoptosis with poor levator muscle function has been challenging. Traditionally, hanging the eyelid to to frontalis muscle above the brow by different materials has been the standard surgical procedure. Recently, frontalis muscle transpositioning has been introduced for correction of congenital eyelid ptosis. The purpose of the present study was to compare the silicone sling and frontalis muscle transpositioning methods to determine the improvement of eyelid ptosis and complications.

This research is a comparative interventional case series performed on patients with severe congenital ptosis with poor levator function, visiting the oculoplastic clinic in Farabi Hospital, Tehran between 2014 and 2016. Two expert oculoplastic surgeons performed either frontalis muscle transpositioning (F.P.) (group 1) or frontalis muscle sling with silicone rod (A.K.) (group 2). The patients were assessed for measurement of MRD-1, levator muscle function, eyelid crease, amount of lagophthalmos and ocular surface staining with fluorescein, preoperatively and post-operatively one week, one month, and six months..

Thirty-nine patients were included in the study. A total of 57 eyes with levator muscle function less than 5 millimeters were included, and randomly divided into two groups. mean age of the patients undergoing silicone sling surgery has been 7.8 years, and the mean age of the patients undergoing frontalis flap surgery has been 8.05 years. There were 19 patient in group 1 and 20 patients in group 2. The MRD1 value has significantly increased in both groups of patients, but it has decreased in the sling group during the six-month period, while there has not been significant different between the two groups (P = 0.109). Lid lag has been highest in both groups during the first week, and has gradually decreased in both groups. Patients in the group 1 showed less eyelid lag.comapred to frontalis sling (P < 0.05).

Both frontalis muscle transpositioning and frontalis muscle sling methods were effective and comparable for correction of ptosis in patient with congenital blepharoptosis with poor levator function. Frontalis muscle transpositioning showed less lagophthalmos.