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Outcomes of conjunctival-Müller’s muscle resection surgery with and without epinephrine in local anesthetic

ABSTRACT Purpose To determine the effect of epinephrine as an anesthetic adjunct on outcomes of conjunctival-Müller’s muscle resection (CMMR) ptosis surgery. Methods A retrospective cohort study of patients having undergone CMMR with plain local anesthetic (LA) and local anesthetic combined with epinephrine (LA+Epi). Two measures of success were investigated: margin to reflex distance 1 (MRD1) success and overall success. MRD1 success was defined as a postoperative MRD1 between 2-4 mm. Overall success was defined as all of i) MRD1 success, ii) a ≤ 1 mm difference between the eyelid height following the preoperative phenylephrine test and post-operative MRD1 (PE-MRD1 Δ), and iii) symmetrical postoperative contour between both upper eyelids. Study inclusion criteria included blepharoptosis from levator aponeurotic dehiscence and satisfactory response to the phenylephrine test. Exclusion criteria included congenital ptosis, ptosis secondary to another cause, previous ipsilateral eyelid surgery, or a medical condition that may have impacted surgery. Results There were 26 eyelids in the LA+Epi group, and 19 eyelids in the LA group. There was no difference in the two groups in age (P =0.28), pre-operative MRD1 (P =0.37), levator function (P =0.27), intraoperative tissue resection amount (P =0.27), number of weeks postoperatively at final MRD1 measurement (P =0.99), and PE-MRD1 Δ (P =0.08). All patients achieved a symmetrical post-operative eyelid contour. The LA+Epi group had a higher attainment of MRD1 success (P =0.04) and overall success (P =0.045). Conclusions Epinephrine as an anesthetic adjunct improves CMMR outcome. This suggests its use can be considered the standard of care.