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Eyelash Ptosis in Unilateral Myogenic and Aponeurotic Blepharoptosis

A Prospective, Controlled, Before- and After-Study

Kashkouli, Mohsen Bahmani, MD; Abdolalizadeh, Parya, MD; Amirsardari, Anahita, MD; Hadi, Yasaman, MD; Sharepour, Maria, MD; Esmaeilkhanian, Houri, MD

doi: 10.1097/SAP.0000000000001599
Aesthetic Surgery

Purposes The purposes of this study were to compare lash ptosis (LP) with contralateral eyelid in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis before and after the ptosis repair and to assess the correlation between postoperative eyelid height and LP symmetry.

Methods Patients older than 5 years were included from June 2015 to April 2017. Eyelid examination, LP grading (0–3), and photography were performed before and at least 6 months after ptosis repair. Success of ptosis repair (levator resection) was defined as margin reflex distance 1 within 0.5 mm of the contralateral eyelid; LP improvement, as at least 1 grade improvement at the last follow-up; and LP symmetry, as 2 eyelids being within 1 grade.

Results There were 58 patients with MP and 20 with AP, with mean age of 19.2 and 49.5 years and median follow-up of 10 months. Lash ptosis was observed in 89.5% of ptotic and 33.3% of control eyelids. Mean LP grade was significantly higher in the MP (1.5) than in the AP (1.1), which significantly improved to 0.6 and 0.4, respectively. However, it persisted in 50.9% of MP and 31.2% of AP postoperatively. Lash ptosis symmetry was observed in 97.4% of patients, which was not correlated with margin reflex distance 1 symmetry. Lower levator function was the only significant factor correlated with LP.

Conclusion Lash ptosis was significantly worse in MP than in AP. Lower LF was correlated with more severe LP. Ptosis repair resulted in significant improvement of LP and its symmetry with the contralateral eyelid. Lash ptosis symmetry did not correlate with eyelid height symmetry postoperatively.

From the Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Received March 25, 2018, and accepted for publication, after revision July 3, 2018.

Conflicts of interest and sources of funding: The authors have no conflict of interest. This study was funded by Iran University Eye Research Center, which did not have any role in the design, execution, and presentation of results.

This study was presented at the 48th American Society of Ophthalmic Plastic and Reconstructive Surgery meeting, New Orleans, 2017.

Reprints: Mohsen Bahmani Kashkouli, MD, Rassoul Akram Hospital, Sattarkhan Niayesh St, Tehran 1455364, Iran. E-mail:

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