title: Adult-onset exposure keratitis after childhood ptosis repair with frontalis sling procedure.
abstract: OBJECTIVE
  To report the development of adult-onset exposure keratitis in patients having undergone childhood ptosis repair with frontalis sling surgery (FSS).
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  Seven patients having received childhood FSS who were referred to us as adults with a complaint of ocular dryness that did not develop until years after surgery.
  
  
  METHODS
  Single-centre, clinic-based, chart review.
  
  
  RESULTS
  Four patients had bilateral, congenital ptosis and 3 had unilateral ptosis, secondary to childhood trauma (2) and third nerve palsy (1). Mean age at first FSS was 6 years (range, 9 months-14 years). Five patients had received additional ophthalmic surgery, including strabismus surgery (2), repeat FSS (4), and prior failed levator resection (1). Mean age at referral to our centre with complaint of ocular dryness was 37 years (range, 23-46 years). Mean time from most recent FSS to presentation was 23 years (range, 17-36 years). On examination, 6 patients had related eyelid abnormalities, including bilateral entropion (1), ptosis recurrence (4), and peaked upper eyelid (1). All patients had measurable lagophthalmos (range, 0.5 mm-3 mm), and 5 had detectable punctate keratopathy (range, "trace" to "2+" on a scale of 0 to 4+). All patients were offered artificial lubricating drops, and 3 were deemed candidates for corrective eyelid surgery, resulting in improvement of exposure keratitis.
  
  
  CONCLUSIONS
  Adult-onset exposure keratitis should be included as a potential late complication of FSS ptosis repair in children, particularly when multiple surgeries are required or complications occur.
authors.affiliation: University of Ottawa Eye Institute, Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario, Canada. mike.dollin@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Dollin
authors.forename: James H
authors.initials: JH
authors.lastname: Oestreicher
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000151:congenital / Q000601:surgery*; D005152:Facial Muscles / Q000601:surgery; D005260:Female; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery; D055815:Young Adult
chemical_list: D009883:Ophthalmic Solutions