Eyelid Retraction Following Combined Frontalis Flap and Levator Advancement Surgery

An 84-year-old female with a history of bilateral congenital ptosis presented with pain in the OD. The patient had undergone bilateral frontalis flap and levator advancement for decompensated congenital ptosis 18 months prior. On examination, the patient demonstrated significant retraction and contour abnormalities of the right upper eyelid. Slit lamp exam revealed superficial punctate keratitis of the OD. The patient underwent ptosis revision of the right upper eyelid, which revealed scarring of the orbital septum to the advanced levator muscle and a severely fibrotic levator muscle. Following revision of the orbital septum and levator, the patient demonstrated significant improvement in eyelid closure with minimal residual ptosis, recurrent eyelash ptosis, and improved ocular surface comfort.