Strabismus, Cornea, Glaucoma Surgeries Increase Risk of Involutional Ptosis

Cosmetic procedure to strengthen the skin of the eyelids. Non-surgical blepharoplasty on plasma IQ apparatus. Cosmetology for facial rejuvenation. Closeup image. Concept correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face
The study found strabismus surgery had the greatest association.

While investigators have concluded that the onset of involutional ptosis is a multifactorial process, their findings show that risk factors for developing the condition include ocular surgery — specifically strabismus, cornea, and glaucoma surgery — as well as hyperthyroidism and type 2 diabetes. These findings were published in Ophthalmic Plastic and Reconstructive Surgery.

The most common form of ptosis, aponeurotic or involutional ptosis, is typically related to aging. However, over time, other factors have been independently linked to the condition’s development, according to researchers. These factors include chronic contact lens use, trauma, and ocular surgery. Some ophthalmic surgeries seem to pose a higher risk than others.

To investigate the associations between systemic medical conditions, types of ocular surgery, and the development of involutional ptosis, investigators examined the prevalence of involutional ptosis in a large population of adult patients.

The researchers culled 10 years of de-identified patient data from the electronic medical records of 5 large academic medical centers. Patients were selected based on ICD-9 and ICD-10 codes for involutional ptosis. Control patients were age- and gender-matched and randomly selected from a general adult population. The study cohort included 8297 adult patients with involutional blepharoptosis and 13,128 matched controls. The average age was 65 years.

The team determined patients’ systemic comorbidities based on ICD-9 and ICD-10 codes and prior ocular surgeries based on CPT codes. The influence of systemic comorbidities and ocular surgery were examined using logistic regression analysis. The 3 significant risk factors for developing ptosis were ocular surgery, hyperthyroidism, and type II diabetes, with odds ratios of 4.2, 2.5, and 1.45, respectively (P <.05). According to the team’s findings, strabismus, cornea, and glaucoma surgeries were more highly associated with developing ptosis (P <.05). Strabismus surgery had the greatest odds ratio of 3.37, followed by cornea surgery at 2.31, and glaucoma surgery at 1.56.

Investigators note several limitations to this study, including its retrospective nature. Second, many risk factors were treated as independent variables, despite well-known associations between these comorbidities. Additionally, data were extracted from medical records, which may not be complete with correct ICD and CPT codes. Patients with mild ptosis may not have been appropriately coded and could’ve been included in the control cohort. Lastly, researchers presumed that the ocular surgery recorded in the records was conducted on the same eye diagnosed with ptosis. Laterality data was not available in this data set. Researchers contend that the large number of charts analyzed in their study may mitigate some of the influence of these limitations.


Cohen LM, Campbell BC, Esfandiari M, et al. Ophthalmic surgeries and systemic medical conditions associated with the development of involutional ptosis. Ophthalmic Plast Reconstr Surg. 2021;37(2):133-137. doi:10.1097/IOP.0000000000001707.