Purpose

To present the staged surgical management of a complex bilateral ptosis case associated with poor levator function, recurrent entropion, marked limitation of ocular motility suggestive of chronic progressive external ophthalmoplegia, and ptosis silicone sling rupture requiring revision surgery.

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Methods

A 62-year-old female presented with severe bilateral ptosis, involutional entropion, reduced levator function, and severe limitation of ocular motility. Due to the chronic nature of eyelid drooping, the patient had not previously perceived diplopia, which became apparent only after surgical elevation of the eyelids and restoration of the visual axis.

Initial surgical management consisted of bilateral frontalis suspension using silicone rods combined with bilateral lower eyelid retractor reinsertion. Postoperative evolution demonstrated satisfactory eyelid height, improved visual axis exposure, and good eyelid positioning.

Approximately one year later, rupture of the right ptosis silicone sling resulted in recurrent ptosis associated with recurrent right lower eyelid entropion. Revision surgery was subsequently performed using frontalis suspension with band material combined with lateral tarsal strip surgery for entropion correction.

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Results

Following reintervention, favorable functional and aesthetic outcomes were achieved, with restoration of eyelid position, palpebral fissure height, and improved symmetry. Ocular surface protection and complete eyelid closure were maintained despite severe ocular motility restriction and increased exposure risk.

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Conclusion

Management of complex bilateral ptosis associated with poor levator function and ocular motility limitation remains surgically challenging because of recurrence risk, exposure-related complications, and postoperative functional imbalance. Frontalis suspension represents an effective reconstructive option in selected cases. However, individualized surgical planning, material selection, and long-term follow-up are essential, particularly in patients requiring revision surgery after sling failure.

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Additional Authors

First name	Last name	Base Hospital / Institution
Calina Anda	Sandu Boz	Emergency Hospital “Saint Spiridon” Iasi
Anisia-Iuliana	Alexa	Emergency Hospital “Saint Spiridon” Iasi
Olivia Evelina	Necula	Emergency Hospital “Saint Spiridon” Iasi
Alexandra	Toader	Emergency Hospital “Saint Spiridon” Iasi
Alexandra	Plahotniuc	Emergency Hospital “Saint Spiridon” Iasi
Camelia Margareta	Bogdanici	Emergency Hospital “Saint Spiridon” Iasi

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