Achieving symmetry following unilateral ptosis surgery

This study's authors report good symmetry results following unilateral eyelid surgery when the operated eyelid was raised to the height of contralateral side's preoperative, rather than intraoperative, height. However, achieving symmetry following ptosis surgery still remains problematic when considering multiple factors, such as brow position.

The current study included 12 consecutive adults with normal levator function and unilateral involutional ptosis who underwent levator advancement surgery performed by one surgeon. Patients demonstrating Hering phenomenon preoperatively were excluded. Eyelid height was set during surgery to match the contralateral preoperative margin reflex distance (MRD), the distance between the corneal light reflex and the upper eyelid margin. Photographs were taken of all patients before, during and after surgery.

The mean preoperative MRD was 0.63 mm on the ptotic side and 3.83 on the contralateral side. Mean intraoperative MRD for the ptotic side was 4 mm compared with 1.67 mm contralaterally. After a mean follow-up of 4.35 months, mean MRD was 3.80 mm on the operated side and 3.83 mm contralaterally. No patient exhibited more than 0.5 mm of asymmetry, and no patient requested postoperative adjustment. The authors speculate that if intraoperative symmetry had been obtained followed by a postop return of the contralateral eyelid to preop height, a mean 42.1 percent postoperative height asymmetry would have resulted between the two eyelids.

Financial Disclosures
Dr. Goldberg has no financial interests to disclose.