Indian Journal of Ophthalmology

: 1981  |  Volume : 29  |  Issue : 4  |  Page : 415--418

Superior rectus muscle transplantation in severe ptosis

Dhanwant Singh, Gobinder S Dhami, Satinderpal Singh, Gurinder Singh 
 Government Medical College, Patiala, India

Correspondence Address:
Dhanwant Singh
Professor of ophthalmology, Medical College Patiala-147001

How to cite this article:
Singh D, Dhami GS, Singh S, Singh G. Superior rectus muscle transplantation in severe ptosis.Indian J Ophthalmol 1981;29:415-418

How to cite this URL:
Singh D, Dhami GS, Singh S, Singh G. Superior rectus muscle transplantation in severe ptosis. Indian J Ophthalmol [serial online] 1981 [cited 2021 Jan 21 ];29:415-418
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Full Text

Ptosis is not only a visual disability but a great cosmetic handicap for the patient, and surgery is the only choice with which to obtain satisfactory results.

In severe degree of ptosis the function of the levator muscle is absent. In all these cases the levator muscle is more or less fibrotic, there­fore the ptotic lid has poor movements.

Motais used superior rectus muscle for the correction of ptosis. In all these procedures, a portion of the force of the superior rectus muscle was utilized, rest of the muscle remai­ned anchored to the globe. This gave very little elasticity for the proper functioning of the lid ; and in some cases with consequent complica­tions. Total transplantation of superior rectus muscle has been specifically designed for cases of severe bilateral ptosis with no levator func­tion ; but normal superior rectus function. This technique gives excellent motility to the lid and avoids the handicaps met with in past procedures.

This work was started after a personal communication from Dr Daljit Singh, Professor of Ophthalmology, Medical College, Amritsar, who is a pioneer in this technique.


Retrobulbar injection and facial block is given with 2 per cent xylocaine with adrena­line. The upper lid is everted with Desmarre's lid retractor and one stitch is passed through the tarsus near its upper border in the middle. The thread is pulled up so as to fully expose the fornix; Lignocaine with adrenaline is injected under the conjunctiva and under the Muller's muscle so as to facilitate dissection.

Superior rectus stitch is passed near its inser­tion and eye ball is pulled down. The conjunc­tiva is incised along the upper border of the tarsus and is reflected down to the insertion of the superior rectus. The Tenon's capsule is split by spreading scissors along the muscle borders. Superior rectus is exposed by muscle hook passed under it near insertion. The superior rectus muscle is cleared of the con­nective tissue coverings for a distance of about 20 mm. The three whip sutures are passed through the tendon of the superior rectus muscle in the lateral, middle and medial thirds of the muscle. The superior rectus muscle is completely freed from the eye ball by cutting its insertion. The muscle is attached at the junction of the tarsal plate with septum orbi­tale. The conjunctiva is stitched back to its original place and one mattress stitchh is passed through the fornix and tied under a piece of gauze on the skin of the lid to reform the for­nix. Eye is closed by a lid stitch applied to the upper lid and bandaged.


The bandage is opened on the next day. The lid stitch is removed, the eye kept bandag­ed for the next 4-5 days and then opened. The oedema of the lid gradually disappears in about two weeks and. functions of lid are normal in 2-3 weeks time. The conjunctival stitches are removed after ten days and patient is discharg­ed with antibiotic drops, 3-4 times a day.


Our results of ten operations of superior rectus transplantation were highly inspiring. There was one failure, in which we operated upon again from the skin side, tucking of the superior rectus muscle was done. One case showed partial improvement. There was no problem of diplopia in cases of bilateral ptosis, whereas we plan to do tenotomy of superior rectus of the other eye, to correct diplopia and hypotropia, in cases of unilateral ptosis. There was no problem of lagophthalmos. Bell's phenomenon disappeared after 5-7 days. Blink­ing and lid movement in the three directions of gaze were perfect. To conclude, total trans­plantation of superior rectus muscle is an ideal procedure for bilateral severe ptosis[2].


1Berke and Hackensack ; 1949, Trans. Amer. Acad. Ophtbalmol., 53: 499
2Motais ; 1897, Bull. Soc. Frac. Ophthalmol., 15 : 208.