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Blepharoptosis after Modern Phacoemulsification Cataract Surgery: Incidence, Risk Factors and Underlying Mechanisms
Raphael Kilian1,2,3, Andrea Taloni1,3, Valentino De Ruvo1,3,4
1Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.
Journal of Cataract and Refractive Surgery
|June 17, 2026
Summary
Blepharoptosis after cataract surgery is uncommon but possible. Preoperative eyelid conditions and anesthesia type may increase risk, warranting discussion during patient counseling.
Area of Science:
- Ophthalmology
- Ophthalmic Surgery
Background:
- Blepharoptosis, or drooping eyelid, is a potential complication of ocular surgery.
- Modern phacoemulsification with intraocular lens (IOL) implantation is a common cataract surgery technique.
Purpose of the Study:
- To review the literature on the incidence and risk factors of blepharoptosis following phacoemulsification cataract surgery.
- To assess the clinical relevance of this complication.
Main Methods:
- A systematic literature review adhering to PRISMA guidelines was conducted.
- Searches were performed in PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials up to February 2026.
- Included studies evaluated postoperative ptosis after phacoemulsification with IOL implantation, focusing on incidence and risk factors.
Main Results:
- Eight studies involving 863 eyes were analyzed.
- Reported ptosis incidence ranged from 0% to 10.7%, with most studies showing rates below 4.1%.
- Lower preoperative levator palpebrae superioris function and higher preoperative marginal reflex distance 1 (MRD1) were identified as potential risk factors. Topical anesthesia was associated with no or insignificant ptosis.
Conclusions:
- Postoperative blepharoptosis after modern cataract surgery occurs at a low but significant rate.
- Preoperative eyelid characteristics and anesthesia type may influence ptosis development.
- Routine discussion of potential postoperative ptosis during preoperative counseling is recommended.
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