Müller muscle conjunctival resection 1

This video demonstrates a Müller muscle conjunctival resection or MMCR. 4-0 silk traction sutures are place at the eyelid margin and the eyelid is everted over a desmarres retractor The monopolar cautery is then used to make two marks at the superior boarder of the tarsus corresponding to the central third of the eyelid. A mark is then made from the previous marks corresponding to half of the total desired resection. In this case it is 4 mm to make a total resection of 8mm. Toothed forceps are then used to grasp each of the superior marks. The Putterman clamp is then placed flush with the superior tarsal border. A 6-0 chromic suture is then placed in a running mattrees fashion below the Putterman clamp. There is significant debate regarding the preferred suture and method of suture placement. The suture is placed across the eyelid and then turned around. Some surgeons will use a Prolene suture and some will place the suture from the cutaneous side of the eyelid to externalize the eventual knot. The 15 blade makes metal on metal contact with the Putterman clamp to cut across the conjunctiva and presumably the muller muscle. The chromic suture is then tied and cut. Since the knot will be internal on the conjunctival side, a contact lens is placed at the end of the case to prevent ocular irritation. The patient will use antibiotic drops three times per day for one week and return at one week for follow up and contact lens removal.