Evaluating Frontalis Sling Using Silicone Rod In Repair Congenital Blepharoptosis

Abstract

Background: Congenital blepharoptosis with poor levator function is commonly treated by frontalis suspension. Silicone rod has become a popular sling material because of its elasticity, adjustability, and ease of implantation. Objective: To evaluate the effectiveness and safety of frontalis suspension using a silicone rod in the treatment of moderate to severe congenital blepharoptosis. Methods: A prospective uncontrolled clinical traill was conducted at Rizgary Teaching Hospital, Erbil, Iraq, from April 2024 to October 2025. Fifteen patients (20 eyes) with moderate to severe congenital blepharoptosis underwent frontalis suspension using a silicone rod in a Fox pentagon configuration. Preoperative and postoperative assessments included margin reflex distance 1 (MRD1), palpebral fissure height (PFH), levator function, frontalis excursion, complications, and patient satisfaction. Patients were followed for 1 year. Results: Twenty eyes of 15 patients were included. Mean MRD1 improved significantly from 0.25 ± 1.02 mm preoperatively to 2.75 ± 1.38 mm postoperatively (p < 0.001). Mean PFH increased from 4.25 ± 1.56 mm to 10.20 ± 3.18 mm (p < 0.001). Good postoperative correction (MRD1 ≥3 mm) was achieved in 70% of eyes, while functional success (MRD1 ≥2 mm) was achieved in 90% of eyes. Complications included silicone rod rupture in two eyes, infection in one eye, and under-correction in three eyes. More than the half of the patients (66.7%) were  satisfied with the surgical outcome. Conclusion: Frontalis suspension using a silicone rod is a safe and effective surgical option for moderate to severe congenital blepharoptosis with poor levator function, providing significant functional and cosmetic improvement with acceptable complication rates.