Lower eyelid position before and after blepharoptosis repair

Purpose: This study aimed to examine the changes in lower eyelid position after blepharoptosis surgery and the factors that influence the outcome. Methods: We conducted a retrospective study of 155 eyes of 89 patients who underwent blepharoptosis surgery between June 2019 and October 2022. The margin reflex distance (MRD)-1 and MRD-2 were examined preoperatively and 3 months postoperatively in two groups: one with lower scleral show (LSS) (n = 37) and one without LSS (n = 118). The clinical characteristics of the two groups were compared. Results: Both the LSS and non-LSS groups showed significant postoperative improvement in MRD-1 scores (p <.01, p <.01, respectively). MRD-2 was significantly reduced in the LSS group, while it remained unchanged in the non-LSS group (p <.01, p =.27, respectively). There were no significant differences between the two groups in age, sex, history of hard contact lens use, preoperative levator function, use of topical steroids, history of endophthalmic surgery, or history of filtration surgery; however, the LSS group significantly used prostaglandin analogs (PGAs) (p =.03). Postoperatively, MRD-2 decreased in 13 eyes (35.1%) and was maintained in 24 eyes (64.9%) in the LSS group and was maintained in all eyes in the non-LSS group. In the LSS group, we also examined the association between postoperative MRD-2 reduction and the use of PGAs and found that more patients with MRD-2 reduction used PGAs (p =.02). Conclusion: Lower scleral show in PGAs-associated blepharoptosis is expected to improve after blepharoptosis surgery.