Singh Muller Muscle Plication for Slight/Modest Ptosis, by Orbital Approach

Slight/modest ptosis is the simplest thing to treat. There is no need for Fasanella type surgery that cuts many tissue, and also is time consuming. All one has to understand is that Muller muscle is nearly 20 mm wide and 10 mm long. Small ptosis can be managed by the plication of MM through orbital route. The lid is double everted. The upper edge of the tarsal plate is controlled with thick nylon sutures. Three conjunctiva deep incisions are made perpendicular to the edge of the lid margin. The conjunctiva is undermined to expose MM. A suitable length of MM is plicated with sutures, under the three conjunctival incisions. The lid is returned back to normal place. The surgery is done. There is no postoperative reaction. The patient goes home after 4 hours. In this technique, the tarsal plate of other lid structures are not disturbed, cut or sutured. It is an operation every ophthalmologist should be able to do.