Strabismus surgery complicated by levator dehiscence

Purpose: Complications of strabismus surgery include residual strabismus, infection, and anterior segment ischemia. We present a rare case of severe ptosis and complete levator aponeurosis dehiscence after strabismus reoperation. Observations: A 31-year-old female with a history of right eye amblyopia and strabismus presented with right large hypotropia, exotropia and right upper eyelid ptosis. After strabismus surgery, the patient had residual postoperative right hypotropia and ptosis but was lost to follow up for 6 years. She returned with worsening of ptosis after receiving right upper eyelid cosmetic filler injection. Additional strabismus surgical revision to first address the hypotropia was complicated by complete right eyelid ptosis. During eyelid repair, complete right levator aponeurosis dehiscence was noted, and surgical correction was performed. Conclusions and importance: While not commonly discussed as a surgical complication, severe ptosis secondary to complete levator aponeurosis dehiscence can occur after strabismus surgery, possibly influenced by patient- and procedure-related factors.