title: Mullers Muscle Conjunctival Resection for Treatment of Contact Lens-Associated Ptosis.
abstract: OBJECTIVE
  The aim of this study was to look at the surgical outcomes of posterior approach Mullers muscle conjunctival resection surgery for contact lens-related ptosis.
  
  
  METHODS
  This was a retrospective, comparative interventional case series. All patients and controls underwent phenylephrine 10% testing and had a positive response prior to surgical intervention.
  
  
  RESULTS
  Thirty-one eyelids with ptosis were identified in 20 contact lens wearing patients, which were matched with 27 eyelids in 15 controls. The contact lens wearing patients wore contact lenses for a mean of 20.6 ± 12.1 years. More than half (60%) wore soft contact lenses, as opposed to rigid gas-permeable contact lenses. Preoperative margin-to-reflex distance-1 was lower in patients who wore rigid contact lenses (0.8 ± 0.7 mm) as compared with patients with soft contact lenses (1.7 ± 1.1 mm) (p = 0.01). Surgical success, as defined by margin-to-reflex distance-1 ≥3 mm or symmetry of upper eyelid height (within 1 mm), was achieved in 93.5% in the contact lens group and 92.6% of controls. Postoperative margin-to-reflex distance-1 was significantly higher in the contact lens wearers (3.9 ± 1.3 mm) compared with the controls (3.2 ± 1.1 mm; p = 0.01). There was a significant correlation between the amount of tissue resected intraoperatively and the improvement in margin-to-reflex distance-1 (Pearsons correlation coefficient, r =0.36; p = 0.006). There were no surgical complications of any patients in the study.
  
  
  CONCLUSIONS
  Mullers muscle conjunctival resection surgery is an effective surgical correction for contact lens-associated ptosis. Patients can achieve excellent results with minimal risk of residual ptosis or asymmetry.
authors.affiliation: *Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; †Singapore National Eye Center, Singapore, Singapore; ‡Boston Medical Center, Boston, Massachusetts; and §Scripps Clinic, La Jolla, California, U.S.A.
authors.forename: Livia
authors.initials: L
authors.lastname: Teo
authors.forename: Christine P
authors.initials: CP
authors.lastname: Lagler
authors.forename: Geva
authors.initials: G
authors.lastname: Mannor
authors.forename: Lora D
authors.initials: LD
authors.lastname: Glass
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Freitag
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000209:etiology / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery*; D003261:Contact Lenses / Q000009:adverse effects*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors