Abstract
Aims
Postoperative lid malpositions are known complications of routine intraocular surgery and were previously attributed to the use of a bridle suture or the myotoxic effect of retrobulbar or peribulbar anaesthetics. However, lid malpositions are still seen under topical anaesthesia. Recent studies have implicated the lid speculum as a factor. Patients with narrower vertical palpebral apertures have been shown to develop postoperative ptosis more frequently, but the reason is unknown. This is the first study to determine the forces exerted by lid speculae over a range of palpebral apertures.
Methods
Mechanical testing was undertaken using a Bose 3200 materials testing machine. Tests were undertaken on four disposable and four reusable speculae. The force used to compress each speculum was compared over a range of displacements. A two-sample t-test was used to compare the stiffness of the two types of speculum.
Results
The stiffness of the reusable speculum was significantly greater than the disposable speculum (P=0.002). The stiffness of each speculum was greatest at the range of displacement corresponding to the narrower palpebral apertures.
Conclusions
Different speculae exert significantly different forces on patients’ eyelids during surgery. The patients who experience the greatest compression from the speculae are those with the smallest palpebral apertures. This may explain why these patients are more likely to develop postoperative lid malpositions.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hosal BM, Tekeli O, Gürsel E . Eyelid malpositions after cataract surgery. Eur J Ophthalmol 1998; 8: 12–15.
Patel JI, Blount M, Jones C . Surgical blepharoptosis - the bridle suture factor? Eye 2002; 16: 535–537.
Kaplan LJ, Jaffe NS, Clayman HM . Ptosis and cataract surgery. A multivariant computer analysis of a prospective study. Ophthalmology 1985; 92: 237–242.
Linberg JV, McDonald MB, Safir A, Googe JM . Ptosis following radial keratotomy: performed using a rigid eyelid speculum. Ophthalmology 1986; 93: 1509–1512.
Song MS, Shin DH, Spoor TC . Incidence of ptosis following trabeculectomy: a comparative study. Korean J Ophthalmol 1996; 10: 97–103.
Singh SK, Sekhar GC, Gupta S . Etiology of ptosis after cataract surgery. J Cataract Refract Surg 1997; 23: 1409–1413.
Paris GL, Quickert MH . Disinsertion of the aponeurosis of the levator palpebrae superioris muscle after cataract extraction. Am J Ophthalmol 1976; 81: 337–340.
Baggio E, Ruban JM . Postoperative ptosis: etiopathogenesis, clinical analysis, and therapeutic management. Apropos of a series of 43 cases. J Fr Ophtalmol 1998; 21: 361–373.
Parsa FD, Wolff DR, Parsa NN, Elahi AE . Upper eyelid ptosis repair after cataract extraction and the importance of Hering's test. Plast Reconstr Surg 2001; 108: 1527–1536 discussion 1537-1538.
Hurwitz JJ, Smith D, Corin SM . Association of entropion with cataract surgery. Ophthal Plast Reconstr Surg 1990; 6: 25–27.
Bernardino CR, Rubin PAD . Ptosis after cataract surgery. Semin Ophthalmol 2002; 17: 144–148.
Deady JP, Price NJ, Sutton GA . Ptosis following cataract and trabeculectomy surgery. Br J Ophthalmol 1989; 73: 283–285.
Alpar JJ . Acquired ptosis following cataract and glaucoma surgery. Glaucoma 1982; 4: 66–68.
Acknowledgements
We thank Arthritis Research UK for funding the equipment used in this study (Grant number H0671).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
This work was previously presented in a poster format at the Annual Congress of the Royal College of Ophthalmologists, Birmingham, May 2011.
Rights and permissions
About this article
Cite this article
Crosby, N., Shepherd, D. & Murray, A. Mechanical testing of lid speculae and relationship to postoperative ptosis. Eye 27, 1098–1101 (2013). https://doi.org/10.1038/eye.2013.133
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2013.133
Keywords
This article is cited by
-
Lower eyelid involutional entropion following cataract surgery
Eye (2022)
-
Iatrogenic Dry Eye Disease: Dealing with the Conundrum of Post-Cataract Discomfort. A P.I.C.A.S.S.O. Board Narrative Review
Ophthalmology and Therapy (2021)
-
Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial
Scientific Reports (2020)
-
Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis
Graefe's Archive for Clinical and Experimental Ophthalmology (2019)
-
Case Series of Combined XEN Implantation and Phacoemulsification in Chinese Eyes: One-Year Outcomes
Advances in Therapy (2019)
