Objective: To investigate the difference of ocular surface change and restoration after external levator advancement and frontalis suspension.
Methods: Forty-two patients (62 eyes) with congenital ptosis hospitalized in Zhongshan Ophthalmic Center from January to April in 2007 were randomly divided into four groups according to different surgery types and with or without post surgery ophthalmic medication. Schirmer test, tear film break-up time, conjunctiva congestion, cornea fluorescent pigmentation, tarsal gland function, winking frequency, angle of eyelash and eyelid closure were all observed and statistically analyzed in all groups 2 days, 5 days, 7 days and 2 weeks after surgery.
Results: Except 3 patients needed advanced ophthalmic medicine, one of whom was with corneal ulceration and needed another surgery, all the others were observed with ocular surface items altered in varied degrees and gradually returned to normality as the inflammation caused by surgery recovered. Break-up time, winking frequency and eyelid closure were statistically different between the two types of surgery but not between groups with and without post surgery ophthalmic medication. Cornea fluorescent pigmentation was statistically different between groups with and without post surgery ophthalmic medication but not between the two types of surgery. The other items did not have statistical difference in all groups.
Conclusion: The two types of surgery for ptosis correction could alter the ocular surface, but frontalis suspension affect tear film break-up time, winking frequency and eyelid closure much more than levator advancement. Ophthalmic medication after the surgery could only ameliorate cornea fluorescent pigmentation but was not necessarily to restoration of normal ocular surface. Abnormality of eyelash angle was the most dangerous factor to the cornea injury.