Muller muscle-conjunctival resection in a pediatric patient
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:44
This video demonstrates a Muller muscle conjunctival resection in a pediatric patient. In general, I do not do MMCRs in pediatric patients unless they have an excellent levator function, less than 2 millimeters of ptosis, and an excellent response to phenylephrine. A 4-0 silk suture is placed through the upper eyelid at the level of the tarsus. The eyelid is then everted over a Desmarres retractor. The needle tip cautery is then used to make 2 markings at the superior border of the tarsus corresponding to the central third of the eyelid. I think that for pediatric patients, at least a 9 millimeter resection should be performed. This is measured with calipers at 4.5 mm. The Putterman clamp is then placed so that it engages the conjunctiva at the level of the superior border of the tarsus. A portion of the conjunctiva is excised so that the suture knot can be buried. The suture then enters the excised portion of the conjunctiva and is then run in a horizontal mattress fashion just below the edge of the Putterman clamp. This is performed along the length of the eyelid. The suture used here is a 6–0 plain gut suture. The suture is then turned around to complete the passage. It then exits out adjacent to where the entrance was. A 15 blade is then used to make metal-on-metal contact along the Putterman clamp so as not to cut the suture. The suture can then be tied so that the knot recesses into the area where the conjunctiva was excised. The area is inspected. The 4-0 silk sutures are cut. Antibiotic ointment is then placed into the eye. In this case I will patch the patient overnight. Antibiotic ointment is use three times per day and the patient returns in approximately 1-2 weeks.
