Ptosis following radial keratotomy. Performed using a rigid eyelid speculum

Seven patients with acquired ptosis and normal levator function following anterior radial keratotomy are presented. Five of these patients then elected to undergo radial keratotomy of the opposite eye, and four had symmetrical lid fissures (mild bilateral ptosis) after bilateral surgery. Ptosis is a well-known complication of cataract extraction, but has not been reported following radial keratotomy. Unlike cataract extraction, radial keratotomy does not require anesthetic injections, bridle sutures, or conjunctival flaps. The rigid Knapp eyelid speculum used in these cases remains as the only apparent cause of eyelid trauma and subsequent ptosis. During radial keratotomy, the speculum was opened widely in order to provide good corneal exposure and avoid contact with the diamond knife. Contraction of the orbicularis oculi muscle against the rigid speculum may have traumatized the lid, resulting in a levator aponeurosis disinsertion and subsequent ptosis.