Management of postop ptosis depends on severity
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KOLOA, Hawaii — Ptosis is a relatively common but under-recognized risk of intraocular surgery, including cataract surgery, according to a presenter at Hawaiian Eye 2020.
“Patients should be aware that ptosis is a risk, but thankfully most of the time, it corrects itself over time or it’s something we can fix,” Don O. Kikkawa, MD, FACS, the Dr. Trude Kahn Hollander Chair in Ophthalmology at the University of California San Diego Shiley Eye Institute, said.
General risk factors for ptosis include older age, trauma, contact lens use, topical ocular medications and ocular procedures, according to Kikkawa.
“Ptosis can be seen relatively frequently after intraocular procedures, sometimes as high as 20%,” Kikkawa said, citing speculum use, superior rectus bridle sutures, anesthetic toxicity and postoperative inflammation, as possible contributing factors.
When postoperative ptosis does occur, the condition should be observed for up to 6 months, he said. Whereas mild ptosis may resolve, severe ptosis may require surgical intervention.
For symptomatic ptosis, muellerectomy or external levator advancement can provide good repair, he said. If the ptosis is 2 mm or less, a posterior approach should be used with phenylephrine testing to confirm proper muscle function. When the ptosis is 3 mm or greater, then an anterior levator approach should be considered, he said.
“If there is unresolved ptosis after the procedure and after a 6-month waiting period, surgery can be considered and is typically successful,” Kikkawa said. – by Alaina Tedesco
Reference:
Kikkawa DO. When the lights go down in the city: Ptosis after ocular surgery. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosure: Kikkawa reports receiving book royalties from Elsevier and consulting for Horizon Therapeutics.
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