Ptosis is an abnormal drooping of the upper eyelid, with the predominant acquired type in adults known as an aponeurotic ptosis. If this leads to visual field obstruction, surgery is often indicated. Highly standardising surgical technique leads to very predictable outcomes, as seen in cataract surgery. From this it is therefore proposed that standardisation of surgical technique, and modification of technique such that minimal change occurs following post op adjustment, should result in more predictable long-term outcomes in ptosis surgery.

In an attempt to increase the accuracy of this surgery, we have significantly changed our peri-operative technique and introduced a post-operative suture adjustment.

We followed up 25 patients who had undergone this modified procedure and measured their upper lid margin reflex distance (uMRD) and interlid difference, comparing this to the uMRD recorded directly post op. This allowed assessment of the degree of uMRD change and the number of patients with uMRD 2mm ≤ X < 4.5mm.

17 (68%) patients demonstrated a uMRD change of <1mm, 5 (20%) a change of between 1 and 2 mm, and 3 (12%) with a change of ≥2mm. Additionally, 25/25 (100%) had a uMRD directly after surgery 2mm ≤ X < 4.5mm, which then fell to 20/25 (80%) by follow-up. Mean follow up time was 8.3 months.

From the patients followed up, a clear positive outcome was identified, with 22/25 (88%) of patients having uMRD change of <2mm. This positive result is further encouraged by the lengthy time to average follow up compared to previous audits. However, whilst the majority of patients showed reasonable stability post op, the small number of patients that showed change signifies the need to continue to change and standardise our technique even more.