Silicone sling frontalis suspension for congenital ptosis: Outcome of 174 consecutive cases

Clin Exp Ophthalmol. 2022 Aug;50(6):608-614. doi: 10.1111/ceo.14112. Epub 2022 Jun 14.


Background: Frontalis suspension (FS) is the treatment of choice in congenital ptosis with poor levator function. We report the surgical outcome of FS using a double triangle configuration of silicone slings in children.

Methods: A retrospective cohort study of all paediatric patients with simple myogenic congenital ptosis repaired with FS over a 12-year period (2009-2020). Each silicone sling was secured by simple knots. Pre- and post-operative margin reflex distance (MRD1 ) measurements were determined from clinical photographs using ImageJ Software. Main outcome measures were improvement in eyelid height, eyelid asymmetry, reoperation rate and timing.

Results: One hundred and thirty nine patients (174 eyes) were included, with 35 (25%) having bilateral surgery. Mean (±SD) age was 1.4 ± 1.9 years. Mean follow up time was 32 ± 20.5 months. Sixteen patients (11%) had a history of previous ptosis repair surgery. Mean MRD1 improved by an average of 1.5 mm. The final MRD1 in the group of patients who did not have a second procedure was a mean of 2.1 mm. The MRD1 difference between both eyes in all unilateral cases improved from 2.5 mm preoperatively to 1.2 mm at final visit (p < 0.001). In the 123 cases without a history of previous ptosis surgery, repeat ptosis repair was performed in 37 (30%) patients, 34.9 ± 19.9 months after the initial procedure. Overall, repeat repair was performed in 47 patients (34%).

Conclusions: Double triangle silicone sling frontalis suspension has a favourable outcome in two-thirds of paediatric patients with simple myogenic congenital ptosis. Failed cases can be addressed with a second repair, using either autogenous fascia lata or a second silicone sling.

Keywords: congenital ptosis; frontalis suspension; ptosis repair; silicone slings.

MeSH terms

  • Blepharoplasty* / methods
  • Blepharoptosis* / surgery
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Oculomotor Muscles / surgery
  • Retrospective Studies
  • Silicones / therapeutic use
  • Treatment Outcome


  • Silicones