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Christopher Lo, Carisa Petris, Richard Lisman; Transient Dry Eye Following the Fasanella-Servat Operation in the Early Postoperative Period. Invest. Ophthalmol. Vis. Sci. 2016;57(12):676.
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© ARVO (1962-2015); The Authors (2016-present)
The Fasanella-Servat levator resection is a popular, less invasive ptosis repair that involves excision of tarsus and conjunctiva from a posterior approach. The aim is to identify if the amount of tissue excised during a Fasanella-Servat procedure correlates with increased early postoperative dry eye.
An IRB approved retrospective review of a surgeon’s experience over a five-year period was performed. Data from pre and postoperative photographs, operative reports, and postoperative visits was analyzed. Small excision was defined as less than 2 mm tarsus removed, moderate excision was between 2 and 4 mm, and large excision was 4 mm or more removed. Postoperative dry eye was defined as subjective complaints, excessive tearing, foreign body sensation, or use of supplemental lubrication during the first postoperative month with sutures removed and the tarsoconjunctival incision well healed.
In total, 51 patients and 99 eyes were included. Thirty-six (70.5%) of patients were female. Mean age was 68, SD 15.5. Forty-six (90.3%) patients were Caucasian. Average follow up time was 6.9 months, SD 1.4. Forty-one (41.4%) eyes had small, 41 (41.4%) had moderate, and 17 (17.2%) had large corrections. In the group undergoing small excision, dry eye increased from 31.7% to 46.3% in the first postoperative month, without significance (p=0.085). Eyes with moderate correction had increased postoperative dry eye from 12.2% to 51.2% (p<0.05). Eyes undergoing large corrections had increased dry eye from 11.8% to 58.8% (p<0.05). Despite transient increases, only 3 (5.9%) patients had significant dry eye requiring use of ocular lubricants after the early postoperative period.
Dry eye following ptosis repair may be caused by increased evaporative losses, alteration of blink, incomplete closure, injury to accessory lacrimal glands, or decrease of meibomian glands or mucin-secreting conjunctiva. Despite these risks, there was not a significant correlation with dry eye with small corrections. In moderate and large ptosis corrections, there was increased early postoperative dry eye, which was managed with short-term lubricants. Changes in palpebral height, tear composition, and hyperawareness of symptoms may play a role in the transient increase of dry eye symptoms, which resolved after orbicularis contraction frequency and excursion returned by the third postoperative month.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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