Etiology and Treatment of Post-surgical Blepharoptosis

Purpose: To investigate the etiology and the treatment of acquired blepharoptosis inpatients,.especially secondary to surgery.Methods: 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.Results:.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.Conclusion: 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.