Quality of Life Tools Underused in Oculoplastics

An investigation shows a lack of research into postoperative quality of life for patients of certain oculoplastic procedures.

Researchers conducting a major review of current studies on quality of life (QOL) outcomes after oculoplastic surgeries found that most showed “overwhelmingly positive impact,” and yet there were few published analyses of QOL for many types of oculoplasty, according to the literature review published in Ophthalmic Plastic and Reconstructive Surgery.

The systematic PubMed search in July 2019 returned 30 studies that met all inclusion requirements in assessing QOL after ocular surgery for conditions such as nasolacrimal duct obstruction (NLDO), ptosis, brow ptosis, thyroid eye disease (TED), and trauma or diseases requiring eye removal. Sixteen studies originate in Europe, 6 studies from Asia, 5 studies are from North America, 2 studies are from Oceana, and 1 study is from South America. 

“To date, of all oculoplastic surgeries, dacryocystorhinostomy (DCR) has been the most widely researched for its impact on QOL (11 published articles vs 5 for TED, the next most frequently reported diagnosis),” the investigators explain. Less postoperative QOL data was available for conditions including entropion and ectropion, brow ptosis, and orbital wall fractures — and no QOL data found for epiblepharon.

Nearly all of the 11 analyses of DCR demonstrated QOL improvement, revealed in tools such as Glasgow Benefit Inventory (GBI) and NLDO-Symptom Score (NLDO-SS). Six of 11 studies compared endoscopic and external DCR using the surveys: GBI, LAC-Q, and ocular symptomatology questionnaire. While 4 studies showed endoscopic DCR more effective for patient satisfaction or reduced pain, 1 paper reported statistically comparable positive scores in both groups, and 1 paper showed significantly better ocular symptom scores with external DCR than endoscopic laser DCR.  

In examining QOL after ptosis repair, patient perception of postoperative functional gain proved more important than clinical gains such as in visual fields, according to researchers. 

In 3 of 4 studies, researchers employed the Quality of Life and Vision Function Questionnaire (QOLVFQ), and GBI. Overall, patients described heightened psychosocial well-being after surgery, and in an investigation where subjects completed the Hospital Anxiety and Depression Scale (HADS), 80% expressed reduced anxiety. 

Regarding orbital decompression treatment for TED, five studies measured QOL with the Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL) and other postoperative questionnaires. Surveys exhibited patient satisfaction in 3 analyses, with 1 paper reporting high satisfaction even at 10- and 20-year follow-ups. Two of the 5 studies revealed significant improvement in psychosocial factors, and 2 showed important benefits related to appearance. 

Studies analyzing QOL after eye removal asked questions on emotions ith surveys including HADS, short-form health survey (SF-12 and SF-36), Beck Anxiety Scale (BAS), and other questionnaires. Three studies demonstrated benefits such as significantly improved psychological QOL after prosthesis fitting, with one of the investigations showing lower anxiety and depression on all HADS subscales, as well.

A limitation of the review was the wide heterogeneity of methods and questionnaires used — these differences did not allow for a meta-analysis model. However, “QOL studies are a valuable tool for evaluating the benefits of surgical intervention and are an important component of surgical success,” the researchers add. 


Seo ST, Sundar G, Young SM. Postoperative quality of life in oculoplastic patients. Ophthalmic Plast Reconstr Surg. 2021;37(1):12-17. doi:10.1097/IOP.0000000000001681.