Surgical Outcomes of Blepharoptosis in Ocular Prosthesis Patients

OBJECTIVES: To evaluate the surgical outcomes of blepharoptosis in patients with no light perception (NLP) who used prostheses and to assess eyelid symmetry and functional improvement following appropriate surgical management.
METHODS: This retrospective study included 15 patients with prosthesis-related ptosis treated between 2020 and 2024. Demographic characteristics, prosthesis type and duration of use, type of ptosis, preoperative levator function, and surgical technique were recorded. Margin reflex distance 1 (MRD-1) was measured preoperatively and at postoperative 1 week, 1 month, 3 months and 6 months, using standardized digital photographs. Eyelid symmetry, complications, and need for revision surgery were evaluated. Repeated measurements were analyzed using the Friedman test with Wilcoxon signed-rank post hoc comparisons.
RESULTS: The mean age was 40.13±17.41 years (range 15–70 years); 10 patients were female and 5 were male. The mean preoperative levator function was 11.80±3.52. Regarding the underlying causes of eye loss/prosthesis use, 9 (60.0%) were due to trauma, 1 (6.7%) was due to infection, 2 (13.3%) were due to glaucoma, and 3 (20.0%) were due to other causes. 12 patients had evisceration, and 3 patients used a prosthesis over a phthisis bulbi eye. 13 patients underwent Müller Muscle-Conjunctival Resection (MMCR) and 2 patients underwent levator surgery. MRD-1 increased significantly from 1.20±0.94 mm preoperatively to 3.27±0.70 mm at 6 months. Further analysis to determine the source of the difference revealed statistically significant differences between preoperative MRD-1 and postoperative MRD1 at 1 week, 1 month, 3 months, and 6 months. The Friedman test showed a significant improvement over time (p<0.001). Technique comparisons were exploratory due to the small levator subgroup. No significant difference was found between the duration of eye prosthesis use and preoperative MRD-1 (p=0.761).
DISCUSSION AND CONCLUSION: MRD-1 improved from 1.20±0.94 mm preoperatively to 3.27±0.70 mm at 6 months, and eyelid symmetry (≤1 mm) was achieved in 86.6% of patients, demonstrating that ptosis of the upper eyelid in ocular prosthesis patients can be effectively corrected with appropriately selected surgical techniques based on levator function.

Keywords: Eyelid symmetry, margin reflex distance-1, müller muscle conjunctival resection, ocular prosthesis, phenylephrine test