Experience with the modified Putterman procedure.

Results using our modification of the Putterman procedure are reported in 43 eyelids. The procedure is very effective in cases of minimal to moderate eyelid ptosis (3 mm or less) and in the presence of normal levator function. The patients, following a thorough clinical evaluation, are tested using 2.5% phenylephrine eyedrop solution, which acts as an extremely useful prognostic indicator. Depending on the degree of ptosis and the response to phenylephrine, 6 to 9 mm of combined Müller's muscle and conjunctiva is resected using a specially designed clamp under local or attended local anesthesia (no tarsal plate is resected). The incision is repaired using a running 6-0 Prolene horizontal mattress technique, and the ends are brought up through the skin and tied over the tarsal plate. In the treatment of 43 eyelids, with the exception of one slight overcorrection, there were no complications encountered with this simple procedure. Excellent results can be expected in properly selected patients, and recovery time is minimal. Our success in the last 4 years with this modified procedure allows us to strongly recommend it for the correction of mild to moderate ptosis when there is an acceptable response to phenylephrine.