Long-standing blepharoptosis following blunt periorbital trauma: three-year outcome after delayed external levator aponeurosis advancement

Long-standing blepharoptosis following trauma remains incompletely characterised. We report a 57-year-old man with unilateral blepharoptosis of 40 years' duration, with patient-reported immediate onset after blunt periorbital trauma and more recent worsening. The temporal association supports a traumatic contribution, although superimposed involutional aponeurotic change cannot be excluded. Preoperative margin reflex distance 1 (MRD1) and clinical levator function (LF; upper-eyelid excursion) of the affected eyelid were −0.5 mm and 2.0 mm, respectively. Intraoperatively, broad detachment of the levator aponeurosis was identified. After adhesiolysis and lateral horn release, attempted upgaze elicited visible posterior retraction and transmitted tension within the exposed levator–aponeurosis complex; these qualitative findings supported the decision to perform external levator aponeurosis advancement. At 3 years, MRD1 and LF were 2.7 mm and 12.0 mm, respectively. In this patient, very low preoperative clinical LF did not preclude durable improvement in upper-eyelid excursion after release of restriction and levator aponeurosis advancement.