Glaucoma · practice question
Which tissues does the Fasanella-Servat procedure resect?
[READINESS SEED] An adult has 1.5 mm of upper-lid ptosis with good levator function (14 mm) and a positive phenylephrine response. The surgeon plans a posterior tarsoconjunctival resection. Which tissues does the Fasanella-Servat procedure resect?
Show the answer and explanationAnswer and explanation
Answer: A. The superior tarsal border, overlying conjunctiva, and Müller muscle
The Fasanella-Servat procedure clamps and excises the upper border of the tarsus together with the adjacent conjunctiva and Müller muscle, and is suited to mild ptosis of about 2 mm or less with good levator function. Because it sacrifices a strip of tarsus, it is best avoided when future eyelid reconstruction may be needed (the tarsus is a valuable posterior-lamella reserve); the tarsus-sparing Müller-muscle–conjunctival resection is the alternative when tarsal preservation matters.
Clinical pearl: Both Fasanella-Servat and MMCR treat mild ptosis with good levator and a positive phenylephrine test — the discriminator is tarsus: Fasanella-Servat removes it, MMCR spares it. Use ≤2 mm as the correctable amount.