Table 2 Summaries of clinical articles reporting the effect of ptosis surgery on corneal biophysics

Brown et al. (1998) [23]

To evaluate corneal curvature changes after ptosis or blepharoplasty surgeries

Prospective

Anterior levator surgery, tarso-myectomy, conjunctiva-mullerectomy, sling

Standard keratometry and Corneal video-keratography

22 (42)

58

Repositioning of the upper eyelid causes visually significant astigmatic change (30% in ptosis group had ≥ 1D change in astigmatism vs 11% in the blepharoplasty group)

Ugurbas and Zilelioglu [8] (1999)

To determine the effect of congenital ptosis on corneal shape and the development of amblyopia

Cross-sectional

-

Topographic Modelling System

22 (44)

15.5

Ptotic eyes had an increased incidence of bow tie pattern astigmatism, corneal asymmetry, and corneal irregularity. Lack of mirror-image symmetry with the fellow eye was higher in amblyopic eyes

Kumar et al. (2013) [24]

To analyze the effect of congenital unilateral ptosis on the ocular HOA

Prospective case series

-

Topography, HOA with Zywave workstation, Schirmer’s test, Break up time and corneal staining

16 (16)

12.5

There was significant difference noted in the mean 6 mm Zernicke coefficients and total RMS between the ptosis and the fellow eyes. Total coma aberration correlated with BCVA and MRD in the ptosis eyes. There was no correlation between the age and total RMS

Ugurbas et al. (2014) [25]

Tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery for mild to moderate ptosis

Prospective

MMCR

Dry eye questionnaire, Schirmer test, TBUT, vital staining, meibomian gland evaluation and conjunctival impression cytology

16 (16)

51

There was no statistically significant change in the tear function tests and goblet cell densities after ptosis surgery

Wee and Lee (2014) [26]

Clinical outcomes of MMCR in patients with mild to moderate ptosis and the effect of CMMR on DED

Retrospective

MMCR

Schirmer test, ocular surface disease index score, phenylephrine test

30 (51)

55.8

CMMR may benefit patients with mild to moderate ptosis and even those with negative phenylephrine test responses. Goblet cell damage can worsen dry eye symptoms

Fowler et al. (2015) [27]

To assess whether taped vs untaped CS testing reliably predicts improvement following eyelid-lifting surgery in patients with ptosis and/or dermatochalasis

Prospective

Levator resection, blepharoplasty

Mars near contrast card held at 40 cm under standard lighting conditions

41 (78)

-

The mean preop untaped CS was 1.30. The mean preop taped and postop log CS were 1.52 (11.85% increase) and 1.51 (11.44% increase), respectively. The difference between the 2 groups was not statistically significant

Agrawal and Ravani (2016) [28]

To document the changes in astigmatism after ptosis correction

Prospective

Fasanellaservat surgery, levator resection and frontalis sling surgery

VA testing, ptosis evaluation, standardized keratometry with Bausch and Lomb keratometer

30

4–12

The average postop change in astigmatism was 0.43 which was statistically significant

Karabulut and Fazil (2019) [29]

To evaluate corneal refractive and topographical changes after MMCR on mild ptosis

Retrospective

MMCR

Corneal topography (Sirius)

28 (28)

31

BCVA and cycloplegic refraction

did not change significantly. The

mean change in corneal astigmatism, simK, SIf, and CCT did not

show significant differences. Apical keratometry front showed a

significant decrease at 3 and 6 months

Youssef et al. (2020) [30]

To evaluate corneal topographic changes after ptosis surgery

Prospective

Levator resection/ frontalis sling surgeries

Computerized tomography (Sirius 3D rotating Scheimpflug & topography)

30 (30)

24.7

3 months postop, corneal astigmatism, average keratometry, and apical keratometry front demonstrated a significant reduction

The BCVA improved but was statistically insignificant

Gandhi et al. (2020) [31]

To evaluate the effect of frontalis sling surgery for congenital ptosis on corneal curvature and refractive status

Prospective

Frontalis Sling Surgery

Computerized topographer, IOL master, autorefractometer and AS-OCT

48 (60)

18

3 months postop, there was significant reduction of cylindrical by -0.36 D and improvement of BCVA by 0.24 ± 0.04 logMAR. Average keratometry did not change significantly. A greater reduction in astigmatism was noticed in the age group of 5–10 years

Li et al. (2020) [7]

To study the difference in the corneal biomechanical parameters of ptotic and fellow eyes in patients with congenital blepharoptosis

Prospective

Levator resection (LF > 5 mm), frontalis suspension (LF ≤ 5 mm)

LenStar LS900, non-contact tonometer (NCT) and a Corvis ST tonometer

29 (29)

9.7

The Corvis ST parameters (Deformation amplitude [DA], A1 times, and A1 velocity), central corneal thickness (CCT), and IOP with NCT differed significantly between ptotic and fellow eyes. CCT was positively correlated with Length A1 and IOP with Corvis in ptotic eyes

Numata et al. (2021) [32]

To evaluate the corneal topographic changes after ptosis correction with and without deepening of the upper eyelid sulcus

Retrospective

Levator resection surgery

VA: logMAR. Corneal topography was measured using AS-OCT

23 (23)

70

Eyes with deepening of the upper eyelid sulcus blepharoptosis, surgery can change keratometry, cylinder and HOA which can improve the visual function

Mohammed et al. (2021) [28]

To evaluate corneal topographic changes after eyelid ptosis surgery

Prospective

Levator resection

Corneal topography (Sirius)

50

20.7

Flattening of superior cornea shown by significant decrease in apical keratometry front

Assadi et al. (2021) [33]

To evaluate the changes in corneal topography, cycloplegic refraction, and BCVA after ptosis correction surgery in patients with congenital ptosis

Prospective

Isolated congenital ptosis: frontalis sling surgery. Marcus Gunn Jaw Winking Syndrome: LPS disinsertion with frontalis sling surgery

Orbscan 3

21 (27)

11.6

A significant decrease in steepest K was noted postop. Inferior K also decreased significantly. However, change in I-S asymmetry was not significant. Variation in BCVA and cycloplegic sphere and cylinder was minimal. Sim K astigmatism, surface regularity index, I-S asymmetry and central corneal thickness did not show significant variation

Mongkolareepong et al. (2021) [34]

To evaluate the predictive factors of postop corneal astigmatism change after ptosis surgical repair

Retrospective

Congenital: supra maximal levator resection Acquired: levator resection

Nidek Tonoref II Autorefractor Keratometer

28 (42)

16.7

A significant postop corneal astigmatism change was only observed in a subgroup of eyes with preop astigmatism of ≥ 1.5 D. 72.2% of these eyes showed a reduction of astigmatism with a mean change of 0.65 D

Abdel Rahman et al. (2022) [35]

To evaluate the corneal topographic changes after levator resection surgery

Prospective

Transcutaneous levator muscle resection

Topography, Snellen chart and TBUT

20 (20)

6.5

K1, K2, and astigmatism were reduced but not significantly

Ceylan et al. (2022) [36]

To evaluate the effect of upper eyelid surgery on ocular surface and corneal topography

Prospective

Group 1: upper eyelid blepharoplasty

Group 2: upper eyelid blepharoplasty and levator advancement ptosis surgery Group 3: levator advancement ptosis surgery

TBUT, ocular surface disease index, Schirmer’s, Autorefractometry and corneal topography (Oculus Pentacam HR)

20 (32)

44

Schirmer test results decreased significantly at 6 months in groups 1 and 2. TBUT values decreased at 1 week in group 3 but returned to baseline at 1 month. Corneal punctate staining was detected at day one and week one in all groups. Group 3 showed a significant change in K2 values at one month