Whitnall ligament (superior transverse ligament of the orbit) is a condensation of the superior orbital fascial system that acts as a pulley for the levator palpebrae superioris. It is formed by the fusion of the levator muscle sheath with the sheaths of the superior rectus and superior oblique at approximately the level of the equator of the globe. The ligament attaches medially to the trochlea and laterally to the lacrimal gland fossa and the lateral orbital wall.
Acts as a fulcrum or check for the levator palpebrae superioris, changing the direction of pull from posterior-to-anterior (muscle direction) to vertical (effective lid-lifting direction), and limits downward globe displacement in a manner analogous to Lockwood ligament inferiorly.
Whitnall ligament is a key surgical landmark in blepharoptosis surgery. In levator resection procedures, the levator aponeurosis is identified posterior to Whitnall ligament, and the ligament itself must be preserved to maintain the functional fulcrum. In brow lift surgery, the levator complex and Whitnall ligament are part of the structures repositioned when the orbital septum and brow are elevated. Disruption of Whitnall ligament produces lagophthalmos and altered upper lid crease position.
Inadvertent division or disruption of Whitnall ligament during ptosis repair alters the effective direction of levator pull and the eyelid crease height, potentially producing overcorrection, high crease formation, or lid lag requiring revision surgery to restore the correct levator mechanism.
