Ptosis

Ptosis of the upper eyelid is common with age: in a sample from a Korean national survey (KNHANES 2010-2012) covering 10,387 adults aged 40 and over, 15.8% presented with ptosis, defined by a margin-reflex distance of less than 2 mm. This survey mainly studied the association between cataract and ptosis.

In a non-randomised retrospective series of 231 patients (372 eyelids) operated on for involutional ptosis, the success rate for the 142 eyelids with severe ptosis was 97.2% after resection of Müller’s muscle and the conjunctiva, compared with 77.4% after external levator muscle resection. As the patients operated on by the posterior approach were selected on their response to the phenylephrine test, this comparison does not allow the superiority of one technique to be concluded.

In a series of 122 procedures for severe aponeurotic ptosis performed by the posterior approach, the overall success rate was 80.3%. The failures corresponded mainly to undercorrection (75% of unsuccessful cases).

In a cross-sectional study conducted in adults aged 50 and over, the prevalence of ptosis reached 27.2%, and older age, male sex, a higher fasting blood glucose and a lower frequency of physical activity were independently associated with it.

In a series of 51 eyelids operated on for involutional ptosis by external levator advancement, the success rate was 86%, and a positive preoperative phenylephrine test was significantly associated with a better result, including on symmetry.

In a series of 50 patients operated on for involutional ptosis and assessed by questionnaire six to eight weeks after the procedure, 16 of the 24 items analysed improved significantly in unilateral forms and 18 out of 24 in bilateral forms; the activities most improved were fine manual work, reaching for objects located above the line of sight, television and reading.