Ophthalmology
Volume 118, Issue 12 , Pages 2510-2517, December 2011

Functional Indications for Upper Eyelid Ptosis and Blepharoplasty Surgery:

A Report by the American Academy of Ophthalmology

  • Kenneth V. Cahill, MD

      Affiliations

    • Ophthalmic Surgeons and Consultants, Columbus, Ohio
    • Corresponding Author InformationCorrespondence: Kenneth V. Cahill, MD, Ophthalmic Surgeons and Consultants, 262 Neil Avenue, Suite 430, Columbus, OH 43215-2362
    • ,
  • Elizabeth A. Bradley, MD

      Affiliations

    • Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
    • ,
  • Dale R. Meyer, MD

      Affiliations

    • Department of Ophthalmology, Albany Medical College, Albany, New York
    • ,
  • Philip L. Custer, MD

      Affiliations

    • Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
    • ,
  • David E. Holck, MD

      Affiliations

    • Aesthetic, Facial and Oculoplastic Surgeons, San Antonio, Texas
    • ,
  • Marcus M. Marcet, MD

      Affiliations

    • Eye Institute, University of Hong Kong, Cyberport, Hong Kong
    • ,
  • Louise A. Mawn, MD

      Affiliations

    • Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee

Received 31 March 2011; received in revised form 12 September 2011; accepted 16 September 2011. published online 24 October 2011.

Available online: October 21, 2011.

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 studies 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 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 eyelid blepharoplasty.

Conclusions

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.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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 Manuscript no. 2011-515.

 Prepared by the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel and approved by the American Academy of Ophthalmology's Board of Trustees February 26, 2011.

 Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

 Funded without commercial support by the American Academy of Ophthalmology.

PII: S0161-6420(11)00885-2

doi:10.1016/j.ophtha.2011.09.029

Ophthalmology
Volume 118, Issue 12 , Pages 2510-2517, December 2011

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