Figure 6. Meticulous removal of the pretarsal orbicularis muscle in a patient with blepharospasm and apraxia of lid opening. Every fiber of the orbicularis muscle is being removed down to the lid margin. Note the tarsal plate, pretarsal skin and the base of the lash follicles at the lid margin. The retracted levator aponeurosis under the orbital fat superiorly will be sutured to the tarsal plate to elevate the eyelid and correct the ptosis.

Figure 6. Meticulous removal of the pretarsal orbicularis muscle in a patient with blepharospasm and apraxia of lid opening. Every fiber of the orbicularis muscle is being removed down to the lid margin. Note the tarsal plate, pretarsal skin and the base of the lash follicles at the lid margin. The retracted levator aponeurosis under the orbital fat superiorly will be sutured to the tarsal plate to elevate the eyelid and correct the ptosis. [Back to text]