Evaluation of Outcome of Various Surgical Procedures for Upper Eyelid Ptosis

Abstract

INTRODUCTION:There are various procedures available for ptosis correction. Successful outcome not only depends on correct technique but also choosing appropriate procedure for each patient. Selection of procedure is based on available levator function and also other factors like etiology, severity, Bell's phenomenon etc. If such varied procedures are performed in a group of patients based on standard criteria and results are evaluated systematically we can determine what works best for a given patient. AIM: Evaluation of outcome of various surgical procedures for upper eyelid ptosis. METHODOLOGY: 25 eyelids of 20 patients who presented to a tertiary centre in south India with complaint of drooping of upper lid were considered. All subjects underwent complete ocular examination corrected visual acuity and detailed ptosis evaluation with particular emphasis on measurement of levator muscle function, MRD1 (margin reflex distance-1), palpebral fissure width in different gazes and margin crease distance. The effect of various factors like MRD1, MCD, levator function were assessed, the amount of correction required and appropriate surgical procedure was chosen. Surgical procedure of Levator resection, frontalis sling operation, anterior levator aponeurosis advancement, or other ptosis correction procedures under appropriate anaesthesia were performed. Post-operative evaluation in terms of visual acuity, MRD, Interpalpebral fissure height, lid symmetry, lagophthalmos and complications (if any) was done. RESULTS: Levator muscle resection was done in 28% of eyelids, frontal sling surgery in 60% of eyelids, Levator muscle plication in 8% eyelids and levator muscle disinsertion with frontal sling surgery in 4% eyes. Undercorrection was seen in about 44% of eyelids in varying degrees. 56% of the eyes had optimal correction. Symmetric correction was achieved in 76% of eyelids. CONCLUSION: The influence of various preoperative factors on the outcome of surgery was assessed. Undercorrection was the most common complication noted. Resurgery in view of undercorrection was required in one of the eyelids.