Complications of levator resection and aponeurosis advancement

Overcorrections - if the lid is very high then immediate lowering is required. If the

Anterior Levator ResectionPang Sutures

overcorrection is mild, instruct the patient to massage the lid with traction on the lashes regularly for up to three months. Wait six months and reassess.

Undercorrections - if marked, immediate re-do surgery is indicated. If mild, wait six months and review.

Abnormal contour - selective recession or advancement of the levator or aponeurosis.

Lagophthalmos and exposure - regular lubricant drops and ointment. Lowering the lid may be necessary if the cornea is jeopardised, requiring recession of the levator muscle.

Conjunctival prolapse - occurs more commonly with large levator resections if the suspensory ligament of the superior fornix is incised or prolapses. Copious lubricants should be given initially but if the prolapse does not settle after days to weeks then insert Pang-type sutures (full thickness sutures from superior fornix through the skin crease) or excise the prolapsed conjunctiva.

Lash ptosis - an inadequate skin crease requires reformation. However, if the skin crease is satisfactory, then an anterior lamella reposition is indicated.

Ectropion - this may occur if the levator is sutured too low onto the anterior surface of the tarsus or if placement of the sutures during skin crease reformation is too high. To correct the ectropion, the sutures need to be repositioned.

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