• In 68 consecutive patients with congenital blepharoptosis undergoing levator muscle resection, a formula derived from the preoperative margin limbal distance (MLD) was used to determine the amount of levator resection. Excellent results were achieved in 86% of 43 patients with unilateral blepharoptosis when this formula was followed. Of 25 patients with bilateral blepharoptosis, excellent results were achieved in 76% of eyelids. When compared with Berke's method, the MLD formula was superior in unilateral cases and almost equal in bilateral cases. The MLD formula gave the surgeon an excellent preoperative prediction of the amount of levator to resect and aided in the placement of the initial tarsal-levator suture. In unilateral cases, little if any tarsal-levator adjustment was necessary. In bilateral cases, Berke's intraoperative values enabled the surgeon to refine the MLD determination.
Sarver BL, Putterman AM. Margin Limbal Distance to Determine Amount of Levator Resection. Arch Ophthalmol. 1985;103(3):354-356. doi:10.1001/archopht.1985.01050030050019