Topical Corticosteroids Associated With Ptosis Severity

Ptosis (Droopy eyelid) in asian male oily skin type with dark eye bag
Study finds risk of ptosis repair failure and recurrence are linked to topical corticosteroids, regardless of specific drug prescribed.

Patients undergoing treatment with topical corticosteroids may need additional counseling regarding the greater risk of ptosis and chances for later ptosis repair failure, particularly with external levator advancement and resection (ELR), according to data posted in Ophthalmic Plastic and Reconstructive Surgery.

In an analysis of 406 eyelids (240 patients), investigators discovered “more severe presenting ptosis” and a higher rate of ptosis recurrence among patients with a history of topical corticosteroid use. Continued use of this class of drugs may also create a continuing risk factor during patient recovery after reparative surgeries, especially with ELR, they added. The levator palpebrae superioris consists of slow-twitch muscle, along with fast-twitch muscle fibers which could be susceptible to atrophy upon chronic corticosteroid exposure.

In the retrospective, case-controlled chart review, ptosis recurred in 30% of eyelids with previous topical corticosteroid use, while only 16% of those who had no regular exposure saw recurrence (P =.03). Mean survival rate of repair success was about 6.4 months for participants with prior topical corticosteroid use, but 11 months for those without (P =.02). No statistically significant correlations were found for ptosis relapse based on which corticosteroid was used (P =.17), or exact duration of use (P =.97).

For those whose ptosis reappeared after ELR, 41% had prior topical corticosteroid exposure, as compared with 18% who did not (P =.01). Recurrence rates were lower in recipients of Müller muscle conjunctival resection (MMCR). After MMCR, 12% of corticosteroid-exposed subjects’ ptosis returned, as opposed to 9% of non-corticosteroid users (P =.76). Researchers added that the Müller muscle is sympathetically innervated and mostly made up of collagenous fibers. 

Previous studies have shown an association between ptosis and ocular or periocular corticosteroid injections; however none have yet examined the relationship of ptosis repair success with topical corticosteroids until the present analysis, the investigators wrote. Limitations of the study include its retrospective nature, and possible complicating variables such as eyelid muscle tone, and prior procedures including glaucoma filtering surgery. 

Participants received at least 3 months of postoperative care. Overall, 44 eyelids of 36 patients had previously taken topical corticosteroids regularly during a mean period of 3.77 years for participants experiencing no recurrence of ptosis, and 3.73 years for those who had recurrence. The study’s designers defined surgical failure as patient or surgeon dissatisfaction with eyelid height, or upper eyelid margin reflex measurement less than 2 mm.

The research speculates that postoperative corticosteroid use may delay eyelid recovery due to impaired muscle healing. “Given the severity of presenting margin reflex distance and the degree of impaired levator function, it is possible that chronic topical corticosteroid use has effects on multiple eyelid retractor tissues, particularly the levator muscle.”


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