Purpose

The management of myopathic ptosis presents a significant surgical challenge, as it requires careful balancing between maintaining corneal protection and achieving an adequate visual axis. The Tarsal Switch technique, a posterior approach, enables such balance by elevating both the upper and lower eyelids while preserving the palpebral fissure height.

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Methods

We describe a case series of patients who underwent the Tarsal Switch procedure performed by a single surgeon.

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Results

The procedure was performed on seven eyes in five patients. All patients presented with myogenic ptosis, inferior scleral show, and poor Bell’s phenomenon. Postoperatively, margin reflex distance 1 (MRD1) increased by 1.5–3.8 mm (mean, 2.5 mm), while margin reflex distance 2 (MRD2) decreased by 0.5–2.1 mm (mean, 1.3 mm). No intraoperative complications occurred. During follow-up, no clinically significant corneal exposure–related complications were observed; one patient with pre-existing dry eye syndrome required punctal plug insertion. No patient required reoperation throughout the follow-up period.

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Conclusion

The Tarsal Switch technique is a safe and effective single-stage procedure for the correction of myogenic ptosis in selected cases. It provides meaningful functional improvement, particularly in patients for whom alternative surgical approaches may carry a higher risk of postoperative corneal exposure.

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Additional Authors

First name	Last name	Base Hospital / Institution
Arie	Nemet	Meir Medical Center

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