Case Report of International Journal of Case Reports
Ptosis resolved after cataract surgery – A case report
Ming Chen, MD, MSc, FACS
University of Hawaii.
It is well known in the literature that adult ptosis can be induced or worsen by cataract surgery even with modern sutureless clear cornea phacoemulsification. [1, 2, 3, 4,5,6,7,8] We are presenting this unusual case was the opposite. The ptosis resolved after cataract surgery. A possible effect from the successful management of dry eye disease before cataract surgery is explained.
Drooping of the unilateral upper eyelid is unilateral ptosis. Ptosis may be myogenic, neurogenic, and aponeurotic from healthy aging, injury, eye diseases. [9, 10] Ptosis also can be associated with hard contact lens wear, immunological, degenerative, or hereditary disorders, tumors, or infections. 
Patients with ptosis often present with a lower position of the upper eyelid, complain of a tired appearance, and defect in their superior visual field even blurred vision. The levator muscle controls the position of the eyelid and is innervated by the oculomotor nerve. The Mueller muscle also controls partially by providing sympathetic innervation. The deficiency of these two muscles may cause ptosis. 
Hering’s law of motor correspondence of a ptosis lid can affect the contralateral lid position [5, 7] as the levator muscles work in synchrony with each other. Therefore, unilateral ptosis can induce a retraction of the contralateral lid or a pseudo retraction. When ptosis is causing visual field defects, the innervation input to both eyelids will increase to reduce the ptosis. There will be a compensatory elevation of eyebrow to reduce the amount of ptosis.  These phenomena need to be considered in the evaluation of unilateral ptosis for surgery. Another essential examination, such as Margin Reflex Distance 1 (MRD1), is the crucial measurement for ptosis besides levator function and palpebral fissure. MRD1 is the distance from the margin of the upper lid to the central corneal reflex (normal is between 4.0-4.5 mm). 
Keywords: Ptosis, cataract surgery
How to cite this article:
Ming Chen. Ptosis resolved after cataract surgery – A case report. International Journal of Case Reports, 2020; 4:157. DOI: 10.28933/ijcr-2020-08-2808
1. Kaplan LJ, Jaffee NS.Clayman HM, Ptosis and cataract surgery. A multivariate computer analysis of a prospective study, Ophthalmology 1985; 92(2):237-242
2. Puvanachandra N, Hustler A,Seah LL, Tyers AG The incidence of ptosis following extracapsular and phacoemulsification surgery: comparison of two prospective studies and review of the literature. Orbit 2010; 29(6):321-323
3. Kashkouli MB, Abdolalizadeh P, Es’Haghi A, et Al, Postoperative blepharoptosis after modern phacoemulsification procedure, American journal of ophthalmology, 2020: 213:17-23
4. Loeffler M, Solomon L, Renaud M. Post Cataract extraction ptosis: Effect of the bridle suture. J Cataract Refract Surg 1990;16:501-540.
5. Patel JI, Blount M, Jones C. Surgical blepharoptosis—the bridle suture factor, Eye 2020;16: 535-537.
6. Linberg JV, McDonald MB, Safir A. Google JM. Ptosis following radial keratotomy, Ophthalmol 1986;93:1509-1512
7. Parsa FD, Wolff DR, Parsa NN, Elahi aE E Upper eyelid ptosis repair after cataract extraction and the importance of Hering’s test., Plast Reconstr Surg. 2001 Nov;108(6):1527-36; discussion 1537-8.
8. Parsa FD, Roach JM. A case report on spontaneous return of levator functions following post cataract blepharoplasty repair. Ann Plast Surg 1996;37: 638-649
9. Finsterer J. Ptosis: causes, presentation, and
a. management Aesthetic Plast Surg. 2003 May-
b. -Jun;27(3):193-204. Epub 2003 Aug 21
10. Watanabe A, Araki B, Noso K Kakizaki H ,Kinoshita S, Histopathology of Blepharoptosis Induced by Prolonged Hard Contact Lens Wear, https://doi.org/10.1016/j.ajo.2006.01.032
11. Zoumalan C; Lisman R, Evaluation and Management of Unilateral Ptosis and Avoiding Contralateral Ptosis, Aesthetic Surgery Journal 30(3) 320 –328 © 2010
12. Lemp M, et Al, DEWS Definition and Classification, the Ocular Surface / April 2007, Vol. 5, No. 2
13. Chen M, MODIFIED SUTURELESS OPERATION FOR MILD BLEPHAROPTOSIS REPAIR International Journal of Academic Research and Reflection Vol. 5, No. 2, 2017 ISSN 2309-0405