A frontalis sling is a ptosis procedure that links the upper eyelid to the frontalis forehead muscle using a sling material. It is used when the levator muscle is very weak.
How It Works
Strips of autologous fascia lata, silicone rods, or other materials are passed in a loop pattern from the lid to the brow. Lifting the brow then elevates the eyelid, compensating for poor levator function.
- Common in severe congenital ptosis with poor levator excursion
- Children may require surgery early to prevent amblyopia
- Sling tension is adjusted to balance eyelid opening and closure
- Material choice affects longevity and ease of later adjustment
Considerations
Because lids rely on the forehead muscle, patients often sleep with partially open eyes and need diligent lubrication. Long‑term follow‑up monitors sling position and ocular surface health.
- Lagophthalmos and exposure keratopathy are key risks
- As the child grows, slings may need tightening or replacement
- Good family education about lubrication and protection is essential
- Frontalis slings can markedly improve visual axis clearance and cosmesis
