Changes in post operative lower eyelid height in patients undergoing ptosis repair
Author: Parinaz Shams
Base Hospital / Institution: Moorfields Eye Hospital
Rapid fire oral presentation
Abstract ID: 24-482
Purpose
To assess the change in lower eyelid position following ptosis repair in patients with congenital or myogenic ptosis (CMP) and those with acquired aponeurotic dehiscence ptosis (AP) and other pre-operative factors such as brow position
Methods
Retrospective case note review of consecutive patients undergoing ptosis repair over a 10-year period. Patients with significant lower eyelid retraction, failure of correction of ptosis post-op, history of Horner’s syndrome, strabismus and simultaneous lower eyelid surgery were excluded. The Marginal reflex distance (MRD) 1 and 2 from the corneal light reflex, the levator function and brow position were measured from pre and post operative (minimum 6 months post-op) clinical photographs using the Image J system.
Results
150 patients met the inclusion criteria of which 61 were CMP and 89 were AP. The mean age was 18 ± 10 years and 61 ± 15 years in CMP and AP groups, respectively. The mean MRD-1 in all patients improved from 1.5 ± 1mm before treatment to 3.8 ± 0.4mm after treatment (p <0.05). The MRD-2 reduced in 41% of cases and remained unchanged in 58%. The MRD-2 decreased from 5 ± 1.0mm pre-op to 4.5 ± 1.0mm post-op (p< 0.001). There was significantly greater lower eyelid elevation seen in those with more severe ptosis (p<0.05). The reduction of MRD2 occurred in 50% of CMP and 34% of AP patients. 75% of those with CMP who developed a reduction in MRD-2 had observable pre-operative brow over-action compared with 44% in those who had no change in lower eyelid position (p <;0.05).
Conclusion
There appears to be a degree of lower eyelid elevation in some patients following ptosis repair. The lower eyelid elevation appears to be more common in CMP and in patients with more severe ptosis and in those with greater degrees of preoperative brow over action. Causative and contributory factors are discussed and implications for surgical outcomes and palpebral aperture height with respect to pre-operative patient counselling considered.
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