Skip to main content
SpringerLink
Log in

Müller’s Muscle-Conjunctival Resection (MMCR) for Management of Blepharoptosis: Posterior Approach

  • Chapter
  • First Online:
Oculofacial, Orbital, and Lacrimal Surgery

  • 1353 Accesses

Abstract

Müller’s muscle-conjunctival resection (MMCR) is a time-tested approach to correct blepharoptosis with normal levator function and positive phenylephrine challenge.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Putterman AM, Urist MJ. Müller muscle-conjunctiva resection. Technique for treatment of blepharoptosis. Arch Ophthalmol. 1975;93:619–23.

    Article  CAS  Google Scholar 

  2. Yazici B, Beden U. Use of 0.5% apraclonidine solution in evaluation of blepharoptosis. Ophthal Plast Reconstr Surg. 2008;24:299–301.

    Article  Google Scholar 

  3. Baldwin HC, Bhagey J, Khooshabeh R. Open sky Müller muscle-conjunctival resection in phenylephrine test-negative blepharoptosis patients. Ophthal Plast Reconstr Surg. 2005;21:276–80.

    Article  Google Scholar 

  4. Georgescu D, Epstein G, Fountain T, Migliori M, Mannor G, Weinberg D. Müller muscle conjunctival resection for blepharoptosis in patients with poor to fair levator function. Ophthalmic Surg Lasers Imaging. 2009;40:597–9.

    Article  Google Scholar 

  5. Maheshwari R, Maheshwari S. Muller’s muscle resection for ptosis and relationship with levator and Muller’s muscle function. Orbit. 2011;30:150–3.

    Article  Google Scholar 

  6. Cohen AJ, Weinberg DA. Müller’s muscle-conjunctival resection for blepharoptosis with poor levator function. Ophthalmic Surg Lasers. 2002;33:491–2.

    PubMed  Google Scholar 

  7. Miller SA, Mieler WF. Systemic reaction to subconjunctival phenylephrine. Can J Ophthalmol. 1978;13:290–3.

    CAS  PubMed  Google Scholar 

  8. Fraunfelder FW, Fraunfelder FT, Jensvold B. Adverse systemic effects from pledgets of topical ocular phenylephrine 10%. Am J Ophthalmol. 2002;134:624–5.

    Article  CAS  Google Scholar 

  9. Stavert B, McGuinness MB, Harper CA, Guymer RH, Finger RP. Cardiovascular adverse effects of phenylephrine eyedrops: a systematic review and meta-analysis. JAMA Ophthalmol. 2015;133:647–52.

    Article  Google Scholar 

  10. Glatt HJ, Fett DR, Putterman AM. Comparison of 2.5% and 10% phenylephrine in the elevation of upper eyelids with ptosis. Ophthalmic Surg. 1990;21:173–6.

    CAS  PubMed  Google Scholar 

  11. Nemet AY. Accuracy of marginal reflex distance measurements in eyelid surgery. J Craniofac Surg. 2015;26:e569–71.

    Article  Google Scholar 

  12. Mercandetti M, Putterman AM, Cohen ME, Mirante JP, Cohen AJ. Internal levator advancement by Müller’s muscle-conjunctival resection: technique and review. Arch Facial Plast Surg. 2001;3:104–10.

    Article  CAS  Google Scholar 

  13. Weinstein GS, Buerger GF. Modification of the Müller’s muscle-conjunctival resection operation for blepharoptosis. Am J Ophthalmol. 1982;93:647–51.

    Article  CAS  Google Scholar 

  14. Ayala E, Gálvez C, González-Candial M, Medel R. Predictability of conjunctival-Müellerectomy for blepharoptosis repair. Orbit. 2007;26:217–21.

    Article  Google Scholar 

  15. Dresner SC. Further modifications of the Müller’s muscle-conjunctival resection procedure for blepharoptosis. Ophthal Plast Reconstr Surg. 1991;7:114–22.

    Article  CAS  Google Scholar 

  16. Perry JD, Kadakia A, Foster JA. A new algorithm for ptosis repair using conjunctival Müllerectomy with or without tarsectomy. Ophthal Plast Reconstr Surg. 2002;18:426–9.

    Article  Google Scholar 

  17. Samimi DB, Erb MH, Lane CJ, Dresner SC. The modified fasanella-servat procedure: description and quantified analysis. Ophthal Plast Reconstr Surg. 2013;29:30–4.

    Article  Google Scholar 

  18. Patel RM, Chuang AZ, Sartori J, Aakalu VK, Putterman AM, Setabutr P. The significance of minimal adjustments in the muller’s muscle and conjunctiva resection procedure to achieve the phenylephrine result. Orbit. 2015;34:79–83.

    Article  Google Scholar 

  19. Migliori ME. Avoiding lid contour abnormalities in Müller’s muscle-conjunctival resection: recognizing the lateral shift. In: Pearls pitfalls cosmetic. Oculoplastic surgery. New York: Springer; 2015. p. 661–2.

    Google Scholar 

  20. Patel RM, Aakalu VK, Setabutr P, Putterman AM. Efficacy of Muller’s muscle and conjunctiva resection with or without tarsectomy for the treatment of severe involutional blepharoptosis. Ophthal Plast Reconstr Surg. 2017;33:273–8.

    Article  Google Scholar 

  21. Liao S-L, Chuang AY. Various modifications of Müller’s muscle-conjunctival resection for ptosis repair. Arch Aesthet Plast Surg. 2015;21:31.

    Article  Google Scholar 

  22. Kavanagh MC, Ohr MP, Czyz CN, Cahill KV, Perry JD, Holck DEE, Foster JA. Comparison of fibrin sealant versus suture for wound closure in Müller muscle-conjunctiva resection ptosis repair. Ophthal Plast Reconstr Surg. 2009;25:99.

    Article  Google Scholar 

  23. Czyz CN, Rich NE, Foster JA, Kavanagh MC, Perry JD, Holck DEE. Comparison of postoperative eyelid position using fibrin sealant versus suture for wound closure in Müller’s muscle-conjunctiva resection ptosis repair. Plast Reconstr Surg. 2011;128:423–30.

    Article  CAS  Google Scholar 

  24. Foster JA, Holck DEE, Perry JD, Wulc AE, Burns JA, Cahill KV, Morgenstern KE. Fibrin sealant for Müller muscle-conjunctiva resection ptosis repair. Ophthal Plast Reconstr Surg. 2006;22:184–7.

    Article  Google Scholar 

  25. Porteous AM, Haridas AS, Collin JRO, Verity DH. Upper lid ptosis surgery: what is the optimal interval for the postoperative review? A retrospective review of 300 cases. Eye. 2018;32:757–62.

    Article  CAS  Google Scholar 

  26. Wee SW, Lee JK. Clinical outcomes of conjunctiva-Müller muscle resection: association with phenylephrine test-negative blepharoptosis and dry eye syndrome. J Craniofac Surg. 2014;25:898–901.

    Article  Google Scholar 

  27. Dailey RA, Saulny SM, Sullivan SA. Müller muscle-conjunctival resection: effect on tear production. Ophthal Plast Reconstr Surg. 2002;18:421–5.

    Article  Google Scholar 

  28. Rymer BL, Marinho DR, Cagliari C, Marafon SB, Procianoy F. Effects of Muller’s muscle-conjunctival resection for ptosis on ocular surface scores and dry eye symptoms. Orbit. 2017;36:1–5.

    Article  Google Scholar 

  29. Michels KS, Vagefi MR, Steele E, Zwick OM, Torres JJ, Seiff SR, Dailey RA. Müller muscle-conjunctiva resection to correct ptosis in high-risk patients. Ophthal Plast Reconstr Surg. 2007;23:363–6.

    Article  Google Scholar 

  30. Georgescu D, Cole E, Epstein G, Fountain T, Migliori M, Nguyen Q, Mannor G, Weinberg D. Müller muscle-conjunctiva resection for blepharoptosis in patients with glaucoma filtering blebs. Ophthal Plast Reconstr Surg. 2007;23:285–7.

    Article  Google Scholar 

  31. Saonanon P, Sithanon S. External levator advancement versus Müller muscle-conjunctival resection for aponeurotic blepharoptosis: a randomized clinical trial. Plast Reconstr Surg. 2018;141:213e–9e.

    Article  CAS  Google Scholar 

  32. Simon GJB, Lee S, Schwarcz RM, McCann JD, Goldberg RA. Müller’s muscle–conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position. Arch Facial Plast Surg. 2007;9:413–7.

    PubMed  Google Scholar 

  33. Thomas GN, Chan J, Sundar G, Amrith S. Outcomes of levator advancement and Müller muscle-conjunctiva resection for the repair of upper eyelid ptosis. Orbit. 2017;36:39–42.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA

    Joshua M. Moran

  2. Eyelid & Facial Plastic and Reconstructive Surgery, Chicago and Glenview, IL, USA

    Adam J. Cohen

Authors
  1. Joshua M. Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam J. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam J. Cohen .

Editor information

Editors and Affiliations

  1. Eyelid and Facial Plastic and Reconstructive Surgery and MediSpa, Diseases and Surgery of the Orbit & Lacrimal System Neuro-ophthalmology, Glenview/Chicago, IL, USA

    Adam J. Cohen

  2. Oculoplastics, Orbital, and Cosmetic Facial Surgery, University of Wisconsin, Madison Department of Ophthalmology and Visual Sciences, Madison, WI, USA

    Cat Nguyen Burkat

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moran, J.M., Cohen, A.J. (2019). Müller’s Muscle-Conjunctival Resection (MMCR) for Management of Blepharoptosis: Posterior Approach. In: Cohen, A., Burkat, C. (eds) Oculofacial, Orbital, and Lacrimal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-14092-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-14092-2_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-14090-8

  • Online ISBN: 978-3-030-14092-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation