Abstract Listings 2026

Purpose

Levator function (LF) is a key parameter in the evaluation and surgical planning of blepharoptosis; however, it does not always correlate with clinical severity or outcomes. This study aimed to compare the histopathological characteristics of the levator palpebrae superioris (LPS) muscle in congenital and acquired (involutional) ptosis with different LF levels.

Methods

This retrospective study included 41 eyelids from patients with congenital or acquired ptosis who underwent anterior levator surgery. Patients were categorized into three groups based on LF: Group 1 consisted of congenital ptosis with LF >5 mm (n=12), Group 2 included acquired ptosis with LF between 9–13 mm (n=13), and Group 3 included acquired ptosis with LF >14 mm (n=16). Excised levator aponeurosis and muscle tissues were examined histopathologically using standard staining. Evaluated parameters included presence of muscle tissue, degree of fat infiltration, fibrosis, edema, and inflammation.

Results

Muscle tissue was present in all specimens. Fat infiltration differed significantly among groups (p = 0.029), being more frequent in Group 1 and Group 2 compared to Group 3 (p = 0.041 and p = 0.039, respectively), while no difference was observed between Groups 1 and 2 (p = 0.218). Severe fibrosis was observed only in Group 1, without statistical significance (p = 0.193). Edema and inflammation showed no significant differences between groups (p = 0.771 and p = 0.359, respectively). Correlation analysis revealed a significant negative correlation between LF and fat infiltration (r = −0.23, p = 0.017) and a positive correlation between LF and muscle content (r = 0.27, p = 0.011) in Groups 2 and 3.

Conclusion

Histopathological alterations, particularly fat infiltration and muscle content, are associated with LF and may partially explain functional variability independent of ptosis etiology.

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