A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel: Kenneth V. Cahill, MD1; Elizabeth A. Bradley, MD2; Dale R. Meyer, MD, FACS3; Philip L. Custer, MD4; David E. Holck, MD5; Marcus M. Marcet, MD, FACS6; Louise A. Mawn, MD7
Ophthalmology, December 2011, Vol 118, 2510-2517 © 2011 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To evaluate the functional indications and outcomes for blepharoplasty and blepharoptosis repair by assessing functional preoperative impairment and surgical results.
Methods: Literature searches of the PubMed and Cochrane Library databases were conducted on July 24, 2008, with no age or date restrictions, and they were limited to articles published in English. These searches retrieved 1147 citations; 87 were reviewed in full text, and 13 studies met inclusion criteria and were included in the evidence analysis.
Results: The 13 studies reported the functional effects and/or treatment results of simulated ptosis; several types of blepharoptosis repair including conjunctiva-Müller’s muscle resection, frontalis suspension, and external levator resection; and upper-lid blepharoplasty.
Conclusion: Repair of blepharoptosis and upper eyelid dermatochalasis provides significant improvement in vision, peripheral vision, and quality-of-life activities. Preoperative indicators of improvement include margin reflex distance 1 (MRD1) of 2 mm or less, superior visual field loss of at least 12 degrees or 24%, down-gaze ptosis impairing reading and other close-work activities, a chin-up backward head tilt due to visual axis obscuration, symptoms of discomfort or eye strain due to droopy lids, central visual interference due to upper eyelid position, and patient self-reported functional impairment.
1The Eye Center of Columbus, The Ohio State University, Columbus, Ohio
2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
3Department of Ophthalmology, Albany Medical College, Albany, New York
4Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
5Aesthetic, Facial and Oculoplastic Surgeons, San Antonio, Texas
6Eye Institute, University of Hong Kong, Hong Kong
7Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee