Evaluation of ocular surface changes following Levator resection Vs Frontalis suspension operations

Abstract

Blepharoptosis is defined as an abnormal low position of the upper eyelid; it can be classified into different subtypes according to age of onset, etiology, severity, and levator function. The effect of ptosis surgery on dry eye is not clear; some authors believe this surgery aggravates dry eye, while others have noted no effect on tear condition, still another group believe it can improve dry eye. Aim of this Work: to compare between levator resection and frontalis sling operations regarding tear film, conjunctival cytology, and topographic changes in order to minimize postoperative morbidity and increase patient satisfaction. Patients and Methods: This study included 30 eyes of 27 patients with moderate to severe ptosis and levator function within 5-6 mm and with the ability to cooperate for examination and investigations. Patients were divided in a randomized manner into Two groups: LR group: 15 eyes underwent transcutaneous maximum levator resection. FS group: 15 eyes underwent frontalis suspension with silicon rods. The patients were subjected to complete ophthalmological examination, special lid examination, tear film examination, conjunctival impression cytology and corneal topography. Results: Tear Break Up Time test decreased in 100% of frontalis sling group, however, it increased in 60% of levator resection group with a statistically significant difference. Schirmer tests were constant or even increased in frontalis sling group (Schirmer 1 was constant in 53.3% of cases and increased in 46.7% of cases, Schirmer 2 was constant in 33.3% of cases, increased in 53.3% of cases and decreased in 13.3% of cases, On the other hand, Schirmer tests decreased in most of patients in levator resection group (Schirmer 1 decreased in 86.7% of cases and was constant in 13.3% of cases, Schirmer 2 decreased in 93.3% of cases and was constant in 6.7% of cases) with a statistically significant difference. Impression cytological analysis revealed that all patients of frontalis sling group developed decrease in conjunctival goblet cells, and all patients of levator resection group showed no change in conjunctival goblet cell. Topographic analysis revealed increased average K in most of frontalis sling group (It increased in 66.7% of cases, decreased in 26.7% of cases and was constant in only 6.7% of cases). On the other hand, average K decreased in all patients of levator resection group (100%) with a statistically significant difference. Regarding corneal with the rule astigmatism and irregularity, both groups showed increase in their values with non-statistically significant difference. Conclusion: Frontalis sling operation adversely affects tear film quality and conjunctival goblet cell density while it increases tear quantity. On the other hand, levator resection operation decreases tear volume with improvement of tear film quality and no change in conjunctival goblet cell density. Frontalis sling increases average K in non-statistically significant manner while levator resection decreases it in statistically significant manner. Both operations increase corneal astigmatism and irregularity in a comparable manner.