Congenital Blepharoptosis, Specifies the Medical Condition or Patient Population Under Investigation

Background: Congenital Blepharoptosis, a common form of ptosis, poses a substantial challenge in achieving consistent postoperative eyelid positioning. The complexity of this condition is evident in the extensive array of techniques available for its treatment, with over 100 reported approaches. Ptosis surgery primarily aims to achieve symmetrical upper eyelid elevation, addressing both functional improvement and aesthetic considerations. Objectives: This study sought to assess the effectiveness of non-absorbable monofilament nylon as a suspensory material in frontalis suspension surgery, utilizing a double rhomboid design. Patients and Methods: A total of 24 eyelids in 15 patients (comprising 8 males and 7 females), with ages ranging from 4 to 19 years, were evaluated. Nine patients presented with bilateral ptosis, while six had unilateral ptosis. All patients exhibited moderate to severe ptosis and poor levator function. The treatment approach involved tarsus to frontalis suspension using 3/0 monofilament nylon with a straight needle, following the double rhomboid design. Results: Among the 24 eyelids studied, functional outcomes with respect to postoperative upper eyelid positioning were as follows: 17 eyelids (70.8%) exhibited good results, 3 eyelids (12.5%) showed fair outcomes, and 4 eyelids (16.7%) displayed poor results, indicating undercorrection or recurrence during the follow-up period. From an aesthetic standpoint, 17 eyelids (70.8%) demonstrated favorable cosmetic results, while 4 eyelids (16.7%) were rated as fair, and 3 eyelids (12.5%) were categorized as poor by three independent observers. A single patient (4.17% of total eyelids) experienced stitch granuloma, and no complications related to lagophthalmos, such as exposure keratitis, were observed in any patient. Conclusion: Non-absorbable monofilament polyamide sutures, such as nylon, offer a viable option as a suspension material in frontalis sling surgery. This approach yields satisfactory aesthetic outcomes, especially when combined with a double rhomboid design, demonstrating its potential as a reliable choice for treating congenital blepharoptosis.