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Müller Muscle–Conjunctival Resection: Effect on Tear Production

Purpose To study the effect of upper eyelid ptosis repair by Müller muscle–conjunctival resection on tear production. Methods The authors retrospectively reviewed the charts of 174 patients who underwent ptosis repair by Müller muscle–conjunctival resection at the Casey Eye Institute between October 1996 and August 2001. After exclusions for insufficient data and confounding ocular morbidities, the charts of 38 patients, consisting of 71 ptosis repair surgeries, were analyzed. A single surgeon performed the same procedure on all patients. All subjects underwent Schirmer testing before ptosis repair and again during the period between 6 weeks to 18 months after surgery. Patients responded to questions pertaining to dry eye symptoms during preoperative and postoperative visits. Results No statistically significant change in tear production (as measured by Schirmer strip testing) associated with ptosis correction by Müller muscle–conjunctival resection was observed. Before surgery, 34% (24 of 71) of eyes measured dry before ptosis repair. This ratio remained unchanged on long-term follow-up. A transient increase in dry-eye symptoms was reported in at least one eye of 29% (11 of 38) of patients in the immediate postoperative period (<2 weeks). On long-term follow-up, a persistent increase in dry-eye symptoms or new diagnosis of dry eye was observed in at least one eye of 16% (6/38) of patients, whereas 13% (5/38) of patients noticed diminution of their presurgical dry eye symptoms. Conclusions Upper eyelid ptosis repair by Müller muscle–conjunctival resection had no significant effect on tear production as measured by Schirmer testing. Subjective dry-eye symptoms transiently increased in the immediate postoperative period but resolved frequently by the late follow-up period.