Studying the impact of topical steroids on ptosis

Why instillation of topical corticosteroids may be associated with greater ptosis and higher rate of failed ptosis repair

Scientists who compared the degree of ptosis and the risk of failed ptosis repair surgery among patients with and without a history of topical corticosteroid use found that instillation of topical corticosteroids was associated with more severe presenting ptosis and increased rates of failed ptosis repair surgery, according to Christopher Dermarkarian, MD, from the Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston.

Dermarkarian and his colleagues conducted a retrospective, case-controlled study that looked at topical corticosteroid use by patients with ptosis who underwent external levator advancement/resection or Müller muscle conjunctival resection.

All patients had a minimal follow-up postoperatively of 3 months. The analyses of the surgical outcomes were compared between patients who used and did not use topical corticosteroids.

Findings

A total of 240 patients (406 eyelids) were included in the study; of those, 36 patients (44 eyelids) had used topical corticosteroids.

The findings, reported in Ophthalmic Plastic and Reconstructive Surgery, differed significantly between patients who used and did not use topical corticosteroids.

The respective mean preoperative margin reflex distances were 0.20 mm and 0.58 mm (p = 0.01); the mean preoperative levator function values were 9.78 mm and 10.38 mm (p = 0.02); and the rates of failed ptosis repair surgeries were 30% and 16% (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.10–4.55; p = 0.03).

The rates of recurrences/surgical type for external levator advancement/resection were 11 of 27 (41%) and 48 of 266 (18%) (OR, 3.12, CI, 1.36–7.15 0; p = 0.01) and for Müller muscle conjunctival resection were 2 of 17 (12%) and 9 of 96 (9%) (OR, 1.29, CI, 0.25–6.56; p = 0.76), the investigators reported.

“Topical corticosteroid use is associated with more severe presenting ptosis and increased rates of ptosis repair failure. Compared to Müller muscle conjunctival resection, a significantly higher rate of ptosis repair surgery failed in patients undergoing external levator advancement/resection,” they concluded.

Reference
  1. Dermarkarian CR, Williams KJ, Sweeney AR, et al. Topical corticosteroid use associated with increased degree of ptosis and rate of ptosis repair failure. Ophthalmic Plast Reconstr Surg. 2021; 37:33-37; doi: 10.1097/IOP.0000000000001671