Alternating ptosis after bilateral frontalis muscle suspension for congenital ptosis

PURPOSE: To report an unusual response to bilateral frontalis suspension su rgery for congenital ptosis, METHODS: Case report. RESULTS: A 6-year old child with infantile esotropia and bilateral congenit al ptosis received a homologous fascia lata frontalis suspension. After sur gery, the patient exhibited an alternating ptosis, caused by alternating un i lateral frontalis muscle contraction, which has persisted throughout 3 ye ars of postoperative observation. CONCLUSION: Symmetric frontalis muscle activation may not always occur afte r bilateral frontalis muscle suspension surgery for congenital ptosis. Ambl yopia, strabismus, or fixation preference may predispose patients to use un ilateral brow elevation, despite bilateral frontalis muscle suspension surg ery. (Am J Ophthalmol 2001; 131:815-816, (C) 2001 by Elsevier Science Inc, All rights reserved.).