• The correction of marked blepharoptosis in patients with severe or potential keratopathy will worsen the keratopathy and possibly lead to the complications of corneal ulceration and endophthalmitis. The conjunctival flap-cosmetic shell-ptosis procedure is well suited to this difficult management problem. Patients are initially treated with a conjunctival flap to protect their cornea. Subsequently they are fit with a cosmetic shell, and finally they undergo surgery to correct their ptosis. This three-stage procedure has produced excellent cosmetic and functional results in two patients, one of whom had ptosis and severe radiation-induced keratopathy following the treatment of a rhabdomyosarcoma; the other patient had severe ptosis associated with lack of corneal sensation and orbicularis function following removal of a cerebral meningioma.
Putterman AM. Conjunctival Flap-Cosmetic Shell-Ptosis Procedure Treatment of Blepharoptosis in Severe Keratopathy. Arch Ophthalmol. 1989;107(12):1816–1818. doi:10.1001/archopht.1989.01070020898035