Clinical and Demographic Characteristics of Blepharoptosis in Korea: A 24-year Experience including 2,328 Patients

Abstract

Purpose: To describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients.

Methods: This is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis.

Results: Of the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation.

Conclusions: Although the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.

Keywords: Blepharoptosis; Classification; Korea; Surgery for ptosis.

Fig. 1. Standard photographs for evaluating levator muscle function (LF) of a young patient whose LF could not be measured accurately. (A) An inert eyelid, extensive eyebrow elevation, no double eyelid crease, severe lid drooping, and chin lifting head posture suggested poor LF (left eye), (B) compared with fair LF suggested by some movement of the eyelid especially on vertical gaze, a double eyelid crease, and mild lid drooping (left eye).

Fig. 2. The cumulative rate of reoperation in (A) congenital and (B) acquired ptosis according to surgical method. AR = aponeurosis repair; LR = levator resection; FL = autogenous fascia lata suspension; SE = Supramid Extra suspension; SR = silicone rod suspension.