Prospective Analysis of Blink Dynamics and Ocular Surface Changes After Levator Aponeurosis Advancement

To prospectively evaluate changes in blink dynamics following unilateral ptosis surgery and to assess their relationship with ocular surface parameters.

Sixteen patients (10 female, 6 male; mean age 56.0 ± 13.2 years) undergoing unilateral levator aponeurosis advancement were enrolled. Incomplete blink percentage and blink rate were assessed using slow-motion smartphone videography. Noninvasive tear break-up time, meibomian gland area loss, palpebral fissure height, and margin reflex distance 1 were measured bilaterally at baseline and at a postoperative visit between day 45 and 60. Ocular surface symptoms were assessed with the Ocular Surface Disease Index.

Incomplete blink percentage increased markedly in the operated eye following surgery (12.0% [0.0-50.8] vs. 67.5% [49.0-90.0], p = 0.001), with patients demonstrating ≥50% incomplete blink rates rising from 37.5% to 75.0%. Meibomian gland area loss also increased significantly (29.2% [17.9-42.1] vs. 36.9% [24.9-47.0], p = 0.016). Blink rate, noninvasive tear break-up time, and Ocular Surface Disease Index did not change significantly. No eye-specific parameter changed in the contralateral eye. A negative correlation was found between preoperative incomplete blink percentage and magnitude of postoperative change (r = -0.606, p = 0.013).

Levator aponeurosis advancement produces a marked and selective increase in incomplete blink percentage accompanied by increased meibomian gland area loss, without affecting blink rate or the contralateral eye. Blink incompleteness may represent a clinically underrecognized consequence of ptosis surgery with long-term ocular surface implications.