Eyelid Contour Following Conjunctival Mllerectomy With or Without Tarsectomy Blepharoptosis Repair

Purpose: To quantitatively determine how accurately conjunctival Mullerectomy with or without tarsectomy (CM +/- T) blepharoptosis repair restores eyelid contour. Methods: The charts of all patients undergoing unilateral CM +/- T blepharoptosis repair at the Cole Eye Institute between June 2012 and September 2014 were reviewed. Preoperative and postoperative digital images were used for eyelid contour analysis. Eyelid contour was measured according to a previously described technique measuring 13 radial mid-pupil eyelid distances (MPLDs) in pixels at 15 degrees intervals from 0 degrees to 180 degrees. Eyelid contour was computed taking the ratio of the corresponding radial MPLD on either side of margin reflex distance (105/75, 120/60, 135/45, 150/30, 165/15, and 180/0) using ImageJ software (National Institutes of Health, Bethesda, MD). Ratios were compared between the preoperative and postoperative images using paired t test with statistical significance set at p < 0.05. Results: One hundred and six cases of unilateral CM +/- T were performed during the study period and 20 cases met inclusion criteria. In the ptotic eyelid, the postoperative eyelid and the unoperated eyelid groups, the average temporal-to-nasal MPLD ratios at corresponding angles from the midline were closer to 1 from 45 degrees to 135 degrees. Then, further from the midline, at more obtuse angles, the temporal MPLD was greater than the nasal MPLD (i.e., the ratio was greater than 1) in all 3 groups. Conclusions: There was no significant difference in any corresponding MPLD or temporal/nasal MPLD ratio between the postoperative eyelid and the postoperative control eyelid. This technique for CM perpendicular to T blepharoptosis repair adequately restores eyelid contour.