Frontalis Sling

Abstract

The frontalis sling is a procedure which is useful in the correction of ptosis in patients with poor levator function. Ptosis is generally considered significant when the margin to reflex distance (MRD) is less than 2.0 mm and there is visual field impairment. Patients with good levator muscle function can generally achieve surgical correction with external levator advancement or a conjunctival-mullerectomy procedure. The conditions of poor levator function combined with ptosis most commonly occur in congenital ptosis, which may require expedited repair when it appears that the ptosis is amblyogenic. The goal of frontalis sling is to attach the eyelid margin to the frontalis muscle, which allows the patient to control the elevation of their eyelid with contraction of the frontalis muscle. The procedure is generally performed bilaterally, but select patients with unilateral ptosis may be addressed with a unilateral frontalis sling, recognizing that the affected side cannot be made “normal.” This chapter will cover the indications for frontalis sling for the correction of ptosis as well as the details of the procedure, complications, and other considerations.