Author Affiliation: Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India.
The recent article by Decock et al1 is very interesting, but after careful reading, I would like to highlight some flaws. First, by histopathological analysis, the authors found the most apical part of the levator muscle (data not shown) to be well-formed striated muscle. In the Comment section, though, they cited the reason behind not attaining normal levator function to be maldevelopment of the muscle, which is contradictory to their findings. If we believe that the levator belly is located 20 to 25 mm instead of 10 mm from the insertion of the tarsal plate in blepharophimosis, then simply reattaching it as in a case of aponeurotic ptosis would elevate the eyelid. However, even supramaximal resection (>30 mm) did not achieve good cosmetic outcome in 4 patients in the study. Moreover, it does not explain why levator function is poor in blepharophimosis but good in aponeurotic ptosis.
Kamal S. Increased Levator Muscle Function by Supramaximal Resection in Patients With Blepharophimosis-Ptosis–Epicanthus Inversus Syndrome. Arch Ophthalmol. 2012;130(10):1356. doi:10.1001/archophthalmol.2012.2217