Open sky Muller muscle-conjunctival resection in phenylephrine test-negative blepharoptosis patients

Purpose: To assess the efficacy of Muller muscle-conjunctival resection in patients in whom the phenylephrine test was negative. Methods: A non-randomized, prospective clinical trial was conducted on 20 eyelids of 15 consecutive patients with blepharoptosis who showed no change in the upper eyelid margin-reflex distance (MRD1) following instillation of topical phenylephrine. The technique used was open sky Muller muscle-conjunctival resection. Results: The mean MRD1 increased by 3.3 mm. No patient required augmentation of the procedure, and all patients had excellent appearance of their skin crease and eyelid contour. No complications arose from the procedure, including no incidence of dry eye symptoms or signs. Conclusions: Muller muscle-conjunctival resection may offer a safe and effective means of treating blepharoptosis despite a negative phenylephrine test.