title: Mechanical testing of lid speculae and relationship to postoperative ptosis.
abstract: OBJECTIVE
  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.
authors.affiliation: Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Crosby
authors.forename: D
authors.initials: D
authors.lastname: Shepherd
authors.forename: A
authors.initials: A
authors.lastname: Murray
mesh_terms: D001763:Blepharoptosis / Q000209:etiology* / Q000517:prevention & control; D004209:Disposable Equipment; D004867:Equipment Design; D006801:Humans; D008422:Materials Testing; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D013525:Surgical Instruments / Q000009:adverse effects*