1 in 5 Trabeculectomy Patients May End up With Ptosis (Eyelid Droop)
[Note: Image is of a severe ptosis. Most ptosis seen after eye surgery is less severe. | Photo credit: “1852 ptosis patient” by William Bell – http://www.flickr.com/photos/22719239@N04/2260115819. Licensed under Public Domain via Commons.]

Trabeculectomy Lowers More Than Just Intraocular Pressure

Anyone who knows the term “trabeculectomy” understands that it is a glaucoma surgery intended to reduce the intraocular pressure (IOP). Most facing this surgery are also aware that trabeculectomy is associated with significant lifetime risk. Few, however, are likely told of a common cosmetic complication: lid droop.

Just how common is this complication? Turns out just under one in five patients who undergo trabeculectomy glaucoma surgery may end up with a significant eyelid droop (also called “ptosis”)[1]. Still, one might argue that as ptosis is not a vision-threatening complication it’s hardly worthy of discussing with every patient who is facing the prospect of glaucoma surgery. At least that seems to be the attitude of a fair number of glaucoma surgeons.

However, just because something is labeled “cosmetic” does not mean that it will have a negligible impact on the patient. Indeed, a recent study performed in the United Kingdom demonstrated that patients with a noticeable lid droop experienced a greater amount of anxiety and depression[2] Worth emphasizing: this study was performed in England. Just imagine what the results would have been had this study been done in the far more appearance-focused USA.

It is a challenge for glaucoma surgeons to discuss both potential vision-threatening as well as cosmetic complications of glaucoma surgery. Surgeons are expected not only to be skilled, but also to balance the constraints of limited time with the need to educate and inform. Nonetheless, even “cosmetic” side effects have the potential to substantially impact a person’s life. Therefore, I believe warning patients of a potential lid droop should be part of the patient-surgeon discussion prior to electing trabeculectomy as one’s glaucoma surgery.

References
  1. Naruo-Tsuchisaka A, Maruyama K, Arimoto G, Goto H. Incidence of Postoperative Ptosis Following Trabeculectomy With Mitomycin C. J Glaucoma. 2015;24:417–420.
  2. Richards HS, Jenkinson E, Rumsey N, et al. The psychological well-being and appearance concerns of patients presenting with ptosis. Eye. 2014;28:296-302.

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, MD is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System. → Learn more about Dr. David Richardson

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