Etiology and treatment of post-surgical blepharoptosis

To investigate the etiology and the treatment of acquired blepharoptosis inpatients, especially secondary to surgery.

The clinical records of 65 consecutive patients with acquired ptosis were reviewed from an eye center and a comprehensive hospital. Potential factors responsible for acquired ptosis were investigated. Surgical management principles and post-operative exposure keratitis are discussed.

The top three causes of acquired ptosis were postsurgical ptosis (20/65, 30.8%), traumatic ptosis (17/65, 26.2%) and senile aponeurotic ptosis (12/65, 18.5%). Twenty patients had post-surgical ptosis secondary to orbital surgery (8/20, 40.0%), enucleation and hydroxyapatite (HA) artificial eye implantation (4/20, 20%), eyelid surgery (3/20, 15%), cataract or glaucoma surgery (2/20, 10%), conjunctive surgery (2/20, 10%) and superior oblique muscle surgery (1/20, 5%). The levator palpebrae superioris (LPS) muscle of ten eyes (10/20, 50%) was found during exploration and reattached to the tarsal plate, with shortening of the LPS. Nine eyes (9/20, 45%) underwent a frontalis suspension (FS) operation because the LPS muscle was missing. One(1/20, 5%) patient was not operated on due to a poor Bell's phenomenon. Two patients (2/65, 3.1%)--one patient with post-surgical ptosis and another with aponeurotic ptosis--developed exposure keratitis after ptosis correction.

Post-surgical ptosis is one of the most common causes of acquired ptosis. It is important to explore LPS muscle during surgery. LPS reattachment is performed if the muscle is found; otherwise, a FS operation is chosen. Exposure keratitis after correction should be monitored.