The Effect of Unilateral Blepharoptosis Repair on Contralateral Eyelid Position

Abstract

Abstract: : Purpose: This study evaluates the effect of unilateral blepharoptosis repair on contralateral eyelid position. Methods: Fifty-four patients (21M, 33F; mean age 65 years) who underwent levator advancement surgery for acquired good-function unilateral blepharoptosis were retrospectively evaluated for postoperative change in contralateral upper eyelid position. Margin-reflex-distance (MRD) measurements taken between one week and six months postoperatively were averaged. Additionally, change in MRD was compared between subjects that on preoperative evaluation did (n=18) and did not (n=36) demonstrate clinically observable eyelid height interdependence, defined as elevation of the ptotic lid resulting in a decrease in contralateral eyelid height, consistent with Hering’s Law, using two-sample t-test. Results: Following unilateral blepharoptosis repair the mean (­+ standard deviation) decrease in contralateral MRD was 0.2 + 0.8 mm. Fifteen percent (12/54) of subjects demonstrated a MRD decrease greater than 1 mm. Three subjects (5.6%) required contralateral blepharoptosis repair within one year of initial surgery. Although the mean decrease in MRD was slightly greater in subjects with preoperative Hering’s Law interdependence, 0.28 + 0.8 mm vs. 0.17 + 0.9 mm, this difference was not statistically significant (p=0.65). Conclusions:Following levator advancement for unilateral blepharoptosis, roughly 15% of patients will have a decrease in contralateral eyelid height greater than 1 mm with 5% requiring surgical repair during the first postoperative year. The degree of change in contralateral eyelid height cannot entirely be predicted by preoperative assessment of Hering’s Law eyelid height interdependence.

Keywords: eyelid • neuro-ophthalmology: diagnosis • ocular motor control