Table 1 Summaries of clinical articles reporting the effect of blepharoplasty on corneal biophysics
From: Corneal biophysical changes after upper eyelid blepharoplasty and ptosis surgery: a review
Author (year) | Aim | Design | Intervention | Methods | Cases (eyes) | Mean age | Outcomes |
|---|---|---|---|---|---|---|---|
Saadat and Dresner (2004) [12] | To assess the safety of blepharoplasty in patients with preop dry eyes | Retrospective | Upper blepharoplasty: skin and fat excision. No orbicularis was excised to preserve innervation Lower blepharoplasty: transconjunctival approach for fat removal | Full history, ocular examination, basic Schirmer test with anesthesia | 67 | 64 | 8% reported worsening in the severity of their dry eyes, 8% improvement, 83% no change By preserving the orbicularis muscle and its innervation, the dynamics of eyelid closure, tear pumping, and tear distribution are not affected |
Kim et al. (2007) [13] | To evaluate the effect of upper eyelid surgery on ocular surface sensation and tear production | Prospective | Blepharoplasty: excision of skin and orbicularis muscle flap Ptosis: orbital septum opened and levator aponeurosis advanced or resected | Cochet–Bonnet esthesiometer, Schirmer 1 test without anesthesia | 11 (21) | 62 | A significant temporary decrease in ocular surface sensation that returns to baseline after 1 month |
Zinkernagel et al. (2007) [14] | To compare the effects of different upper eyelid procedures on corneal topography | Prospective | Skin-only blepharoplasty, blepharoplasty with reduction of the medial fat pad, blepharoplasty with reduction of the entire fat pad, and levator advancement | Computed corneal topography before surgery and at 3 months | 43 (82) | 59 | Statistically significant correlation between the severity of upper eyelid abnormality and topographical corneal changes after surgery Changes in astigmatism were greater when large fat pads were reduced Postop astigmatic axis changes were not systematic |
Rogers et al. (2012) [15] | To assess the effect of upper eyelid blepharoplasty on CS | Prospective | Routine upper eyelid blepharoplasty under local anesthetic | Pelli-Robson chart at 1 m, VA, and automated 60:4 visual field | 14 (28) | 63.5 | Significant increase in log CS from 1.49 to 1.64 |
Kim et al. (2013) [2] | To assess CS and VA after upper eyelid blepharoplasty | Prospective | Excess skin, orbicularis, and fat pad excision | CS was measured by an automated Contrast Glaretester. HOA by KR-1W Wavefront Analyser. Lash ptosis was measured using a 4-point rating scale | 16 (22) | 47.4 | CS significantly increased in every spatial frequency and light condition HOA (total HOA, 3rd and 4th order, trefoil, coma, and second astigmatism decreased significantly. Lash ptosis also decreased after. Corneal topography showed no difference |
Dogan et al. (2015) [16] | To evaluate corneal parameters obtained by Scheimpflug imaging after blepharoplasty | Prospective | Excess skin and fat pad excision | Preop and postop (3rd month) Sheimpflug imaging: CCT, ACD, steepest keratometry, astigmatic power vectors | 30 (60) | 56.5 | The only parameter that was significantly different was the steepest keratometry in patients with preop MRD1 < 2.5 mm Other parameters showed no differences |
Simsek et al. (2015) [9] | To determine any change in corneal astigmatism and VA changes following upper blepharoplasty | Prospective | Routine upper eyelid blepharoplasty surgery | Pentacam and VA before, 1 and 3 months postop | 23 (43) | 46.3 | Statistically significant astigmatic changes (0.15 D); but clinically insignificant VA changes. No significant change in astigmatism axis was detected |
An et al. (2016) [17] | To assess the effects of upper lid blepharoplasty on visual quality | Prospective | Excess skin, orbicularis and fat pad excision | CS: Vector Vision CSV-1000 chart; levator function test; Lash ptosis: 4-point rating scale | 39 (73) | 62.6 | A significant increase in CS under scotopic and photopic conditions were found Lash ptosis also improved |
Kim et al. (2016) [18] | To analyze corneal curvature changes after upper eyelid surgery, and to compare the effects of different upper eyelid procedures on corneal curvature | Prospective | Blepharoplasty: excision of redundant skin orbicularis muscle and fat Ptosis: levator resection | Corneal topography before surgery, and at 6 weeks | 34 (50) | 57.9 | Levator resection showed greater changes of corneal curvature (central corneal power and astigmatism) than blepharoplasty The advanced aponeurosis technique may have a greater effect on the lid/cornea interface |
Rymer et al. (2017) [11] | To evaluate the effects of Muller’s muscle-conjunctival resection (MMCR) on ocular surface and dry eye symptoms | Prospective | Bilateral upper eyelid skin excision with MMCR or skin-only excision | Salisbury Eye Evaluation Questionnaire, Schirmer’s test, TBUT, fluorescein and rose Bengal staining | 46 (92) | 62 | No changes were seen in patients who underwent blepharoplasty alone in the questionnaire scores. No changes were found in tear production profiles in the blepharoplasty-only group. Addition of MMCR to upper eyelid blepharoplasty did not worsen the dry eye profile |
Mohammed (2018) [19] | Study the impact of orbicularis strip excision during upper blepharoplasty on postop dry eye symptoms | Interventional comparative | Upper blepharoplasty ± orbicularis excision | Corneal and tear film, TBUT and Schirmer's tests | 20 (40) | 57 | Orbicularis excision during blepharoplasty causes temporary decrease in TBUT and more occurrences of reversible dry eye symptoms |
Nalci et al. (2020) [20] | To evaluate the impact of upper eyelid blepharoplasty on CS in dermatochalasis patients | Prospective | Skin-only blepharoplasty | CS measured using sine-wave contrast sensitivity chart, corneal topography | 34 (34) | 63 | CS significantly increased after upper eyelid blepharoplasty, especially at higher spatial frequencies (3, 6, 12, and 18 cpd), which are usually reduced in older adults Keratometric and corneal HOAs did not change significantly |
Bhattacharjee et al. (2020) [21] | To analyze the long-term changes in CS and HOAs, and corneal topography after upper eyelid blepharoplasty | Prospective | Excess skin and fat pad excision | CS: Pelli–Robson chart HOAs: WaveLight Allergio analyzer Corneal topography: topographic modeling system-4 | 30 (60) | 56 | At 12 months, the mean CS, the majority of HOAs, and corneal topography (only cylinder) showed a stable, statistically significant difference |
Ekin and Ugurlu (2020) [22] | To evaluate the changes of VA, CS, astigmatism, and HOA after blepharoplasty | Prospective | Excess skin and fat pad excision | Corneal topography (Sirius) | 103 (206) | 56.7 | No significant differences were observed for VA. The CS significantly increased at all spatial frequencies both under glare and nonglare conditions. The mean refractive astigmatism significantly decreased. In patients with MRD < 2 mm, mean CS was increased and mean astigmatism decreased significantly compared with those with ⩾ 2 mm. HOA and root mean square decreased significantly |
Sommer et al. (2022) [4] | To investigate the effect of skin-only upper eyelid blepharoplasty on corneal biomechanics and topographic parameters | Prospective | Excision of redundant skin orbicularis muscle and fat | The corneal resistance factor and corneal hysteresis were assessed by ocular response analyzer Pentacam | 35 (42) | 64.5 | The increasing CH and CRF might indicate a rise of corneal damping capacity. Despite statistically significant differences of Kmax, I-S and ISV, all other tomographical/ topographical parameters did not change. The corneal steepening and the decrease of I-S do not seem to have a clinically relevance |