Blepharoptosis in the Setting of an Ocular Prosthesis: A Literature Review and Description of the Novel Use of a Template Prosthesis

Abstract

Blepharoptosis in acquired anophthalmia is common, yet the best treatment methods remain uncertain. We review the literature for descriptions of pathophysiology or management of blepharoptosis in acquired anophthalmic sockets and describe a technique and results of using a template prosthesis to facilitate intraoperative adjustment during external levator resection ptosis repair. The PubMed database was searched in October 2021 to identify all studies in English describing the pathophysiology or treatment of anophthalmic blepharoptosis. Seventy-one articles were identified; 13 met inclusion criteria and were reviewed. We also reviewed the charts of 12 adult patients with acquired anophthalmia undergoing external levator resection using a limbal templated, non-detailed, customshaped prosthesis. We assessed results (margin to reflex distance 1 [MRD1] and symmetry), as well as the number of eye prosthesis modifications. According to the literature, levator pathophysiology and orbital volume loss are important variables in anophthalmic ptosis. Prosthesis augmentation may be useful to treat ptosis in many instances, but may be limited by decreased motility and a poorer overall prosthesis fit. A variety of blepharoptosis repair surgical techniques have been described with reported success rates of 88–100%. The use of a template prosthesis to facilitate intraoperative lid positioning in ptosis repair was effective in 12 patients. All patients had MRD1 within 1 mm of target and with good facial symmetry. There were no complications or need for revision ptosis repair or redundancy in prosthesis fabrication at 3 years (mean; minimum 6-month) follow-up.