• Khawaja Khalid Shoaib, Muhammad Awaid Abid, Saad Aziz, Fiza Azhar, Muhammad Sohail Shehzad, and Sheikh Muhammad Shahbaz Ali.
• Mughal Eye Hospital Trust, Lahore, Pakistan.
• J Coll Physicians Surg Pak. 2023 Dec 1; 33 (12): 141014131410-1413.

ObjectiveTo analyse the complications after external levator resection (ELR) for ptosis, and their management.Study DesignObservational Study. Place and Duration of the Study: Mughal Eye Hospital Trust, Lahore, from June 2018 to December 2022.MethodologyA total of 256 eyes were operated for ptosis cases having good levator function who were treated by ELR. The exclusion criteria was any history of operation of lids or orbits or poor levator function, Marcus Gunn jaw-winking phenomenon, and neurogenic ptosis. The frequency of complications and their management was documented.ResultsAge ranged from 6 to 65 years. The follow-up ranged from 8 weeks to 3 years. Eleven (4.3%) cases developed complications. Two cases had mild undercorrection and did not require any treatment. In moderate overcorrection encountered in one eye, pulling the lid down for a few times daily improved lid level in four weeks. Four eyes had severe overcorrection, 2 patients required one operation and the other two patients required two operations each. These included hang-back sutures in two eyes (with 5/O Ethibond in one eye and 6/O Vicryl sutures in another eye) and simple incision in the levator (disinserting it partially from the tarsal plate) in two eyes. Lagophthalmos in two eyes improved with conservative treatment. Notching in two eyes improved with partial disinsertion of levator by cutting one Vicryl suture attaching levator to the tarsal plate and leaving 2 Vicryl sutures connecting levator to the tarsal plate.ConclusionPtosis correction by ELR is a low-complication procedure with good corrective results.Key WordsPtosis, Good levator function, Overcorrection after ptosis operation, Hang-back sutures, Partial levator disinsertion.

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