[Surgery of post-traumatic ptosis].

Post-traumatic ptosis may be classified as follows: ptosis occurring during lid avulsion, ptosis associated with fractures of the orbital roof and with foreign bodies, post-contusional ptosis, cicatricial ptosis, neurogenic ptosis and post-surgical ptosis. The patient must be thoroughly examined, including examination of the eye-ball, extra-ocular muscles, eyelid and evaluation of upper eyelid levator function and orbital and facial examination. The various surgical methods proposed include levator muscle surgery, aponeurotic surgery, Müller's muscle surgery and frontalis suspension surgery. Surgical indications and choice of surgical method essentially depend on the anatomo-clinical forms. The general rule is to operate under local anesthesia to obtain better control of the muscular function. Some cases are simple to treat such as post-contusional ptosis with good levator function which allows functional surgery with excellent static and dynamic results. Other relatively simple cases with non functional levators may only be treated on a static basis. Last but not least are more difficult cases in which levator function is difficult to evaluate pre-operatively because of severe fibrosis. The aim in such cases is to explore the eyelid by an anterior approach under local anesthesia and to propose either muscular surgery or a frontalis suspension according to the anatomical and functional status of the levator muscle.