Anterior Levator Muscle Resection and Switch in a Patient With Severe Blepharoptosis and Poor Bell's Phenomenon: A Case Report.

ABSTRACT

This case report describes a novel surgical technique, the "levator switch," for correcting severe blepharoptosis in a 65-year-old man with poor Bell's phenomenon following previous bilateral ptosis surgery. He presented with recurrent ptosis, weak levator function, and excessive frontalis muscle use. The technique involves a sequential approach: anterior levator resection followed by repurposing the resected tissue as a posterior lamellar graft to the lower tarsal border. This elevates the eyelid margin while maintaining a stable palpebral fissure height. The levator switch addresses ptosis from poor levator function and minimizes postoperative corneal exposure. It offers advantages over the existing tarsal switch procedure by preserving the tarsus and meibomian glands, thus maintaining eyelid stability and contour.