LAUSR

BACKGROUND One of the main causes of unsatisfactory outcomes after unilateral blepharoptosis surgery is asymmetry of the upper eyelid height, which occurs as a result of a contralateral eyelid droop. Therefore, we evaluated the efficacy of Müller's muscle-conjunctival resection (MMCR) for the treatment of contralateral ptosis following unilateral external levator advancement (ELA). METHODS This study analyzed 26 eyelids of 26 patients with upper eyelid height asymmetry following unilateral ELA who underwent contralateral MMCR retrospectively. The phenylephrine test was performed before ELA and before MMCR. The main outcome measures were symmetry outcomes and clinical outcomes. RESULTS The mean patient age was 55.81 ± 7.98 years (range, 44-70 years); 15 were (57.7%) female. Hering's dependency was observed in 13 (50%) of the patients before ELA. An adequate response to phenylephrine was observed before MMCR but not before ELA. Symmetry outcomes after MMCR were perfect (<0.5 mm), good (≥0.5 mm, <1 mm), and fair (≥1 mm) in 7, 17, and 2 patients, respectively. An optimal upper eyelid height was noted in 47 of the 52 eyelids after the MMCR, while three of the 52 eyelids had minimal overcorrection, and two eyelids had undercorrection. The mean change in MRD1 of the contralateral eyelid droop was greater for patients with than without Hering dependency (p < .0001) after ELA but not after MMCR. Two patients (7.6%) underwent revisional ELA surgery. CONCLUSIONS MMCR and use of the phenylephrine test to predict the eyelid position may represent an alternative approach in patients who require management of contralateral ptosis following unilateral ELA.