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Reply Re: "Risk Factors for Worsening Dry Eye Symptoms in Patients Undergoing External Levator Advancement Surgery".

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Risk Factors for Worsening Dry Eye Symptoms in Patients Undergoing External Levator Advancement Surgery.

Christine J Zemsky1,2, Larissa K Ghadiali3,4, Noam Rudnick5

  • 1Johns Hopkins, Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.

Ophthalmic Plastic and Reconstructive Surgery
|May 6, 2025
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Summary

External levator advancement surgery can worsen dry eye syndrome (DES). Larger postoperative MRD1 and MRD2 measurements, and MRD1 changes, correlate with increased dry eye symptoms after this procedure.

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Area of Science:

  • Ophthalmology
  • Oculoplastics
  • Dry Eye Disease

Background:

  • Dry eye syndrome (DES) is a common condition.
  • External levator advancement surgery is a procedure to correct ptosis.
  • The relationship between external levator advancement and DES is not well-studied.

Purpose of the Study:

  • To investigate risk factors for dry eye signs and symptoms following external levator advancement.
  • To enhance preoperative planning for external levator advancement surgery.

Main Methods:

  • Retrospective chart analysis of patients undergoing external levator advancement.
  • Measurement of margin reflex distance-1 (MRD1) and margin reflex distance-2 (MRD2) pre- and postoperatively.
  • Assessment of dry eye symptoms (DSXs) at multiple postoperative time points.
  • Subgroup analysis for patients with pre-existing DES and those undergoing simultaneous procedures.

Main Results:

  • Postoperative MRD1, MRD2, and change in MRD1 were significant between patients with worsening vs. non-worsening DSX.
  • In patients with DES, differences in DSX were significant at early postoperative visits but not at 3 months.
  • Worsening DSX in DES patients was associated with a greater change in MRD1, but not final MRD1.

Conclusions:

  • Increased postoperative MRD1, MRD2, and MRD1 change are linked to worsening dry eye symptoms after external levator advancement.
  • In DES patients, a larger MRD1 change correlates with worsening symptoms.
  • Consideration of simultaneous lower eyelid surgery to reduce MRD2 may mitigate postoperative dry eye.