Algorithm for choosing a surgical technique for upper lid ptosis

BACKGROUND: Selection of a surgical technique to treat blepharoptosis is currently based on traditional examination methods, which do not provide comprehensive understanding of functional changes in the upper lid levator associated with ptosis of various types. The percentage of under- and overcorrection remains high because of incorrect preoperative calculations and complications. A comprehensive functional assessment of the upper lid levator and assessment of contractility and fatigability are required, followed by calculation of a motion index.

AIM: Evaluation of the effectiveness of the developed algorithm an algorithm for choosing a surgical technique to treat upper lid ptosis based on dynamic measurement data.

METHODS: From 2020 to 2022, 100 patients with upper lid ptosis were examined. Dynamic measurements were performed in addition to a standard ophthalmological examination, and the motion index was calculated, defined as the ratio of levator contractility to its fatigability.

RESULTS: We have developed a method to determine the motion index and proposed to use it in patients with moderate to severe upper lid ptosis. The treatment strategy was determined based on the motion index according to the developed algorithm as follows: levator aponeurosis advancement procedure is recommended if the motion index is 0.25 or less; levator resection is required with the motion index of 0.26–0.28; for 0.29–0.65 and 0.66 or more, upper lid levator disinsertion and suspension surgery are performed, respectively. This approach provides an adequate functional and good cosmetic effect and reduces the risk of over- or undercorrection in clinical practice.

CONCLUSION: The algorithm for choosing a surgical technique to treat upper lid ptosis has been proposed based on the examination results, including dynamic measurements of the upper lid levator function (contractility and fatigability) and subsequent calculation of the motion index (the ratio of levator’s contractility to its fatigability).