BMJ Case Reports 2018; doi:10.1136/bcr-2017-223743
  • Reminder of important clinical lesson

Tarsal buckle with conjunctival prolapse following levator plication for unilateral congenital ptosis

  1. Asha Samdani
  1. Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, India
  1. Correspondence to Dr Amar Pujari, dramarpujari{at}
  • Accepted 14 March 2018
  • Published 22 March 2018


An 8-year-old child underwent uneventful levator plication surgery for unilateral congenital ptosis. Postoperative course for initial few days was uneventful but on day 7, the patient was brought with conjunctival prolapse from the undersurface of upper eyelid due to tarsal kinking and eversion. Early medical management was initiated with frequent surface lubrication to avoid conjunctiva dryness. Under general anaesthesia, right-sided conjunctival repositioning was performed with an eyelid spatula supplemented by three forniceal stay sutures to retain the conjunctiva in its anatomical place. To reverse the tarsal kinking, continued downward traction suture was placed for a period of 2 weeks. At the end of 4 weeks, the conjunctival prolapse was completely resolved with a well-formed superior fornix. At the end of 3 months, the symmetric eyelid position was maintained without any additional complications.


  • Contributors All authors have evaluated the case in detail followed by optimal surgical intervention to achieve the optimal outcome. After critically analysing the educational value of the case, they wrote the report together.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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