Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis

  • Yijie Wang
  • Lixia Lou
  • Zhifang Liu
  • Juan YeEmail author
Oculoplastics and Orbit



We conducted a systematic review and meta-analysis to evaluate the incidence and risk factors of ptosis following ocular surgery.


PubMed, Embase, and Cochrane Library were searched for articles that assessed the incidence or risk factors of ptosis following ocular surgery up to October 2017. We used a fixed effects model to calculate a pooled estimate of incidence, with subgroup analyses to evaluate the effect of different variables. The relative risks (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) for all available factors were calculated using the fixed effects models.


A total of 16 studies on 2856 eyes were analyzed, including 3 randomized controlled trials (RCTs) and 13 cohort studies. The overall incidence of ptosis following ocular surgery was 11.4% (95% CI 10.1–12.8%). Subgroup analyses showed that the region and the surgery type were significantly associated with the incidence of postoperative ptosis. Men were less likely to get postoperative ptosis than women (OR 0.62; 95% CI 0.43–0.89). However, age (OR 0.77; 95% CI 0.48–1.23), side (OR 1.37; 95% CI 0.84–2.25), type of anesthesia (OR 0.57; 95% CI 0.16–2.05), prior surgery (OR 1.09; 95% CI 0.64–1.83), bridle suture (OR 2.04; 95% CI 0.94–4.42), or combined surgery (OR 0.95; 95% CI 0.58–1.57) did not significantly change the risk of ptosis following ocular surgery.


More than one in ten patients who undergo ocular surgery will develop ptosis. Different regions and surgery types may influence the occurrence of this abnormality. Female gender is a risk factor for development of postoperative ptosis.


Ocular surgery Ptosis Incidence Risk factor Meta-analysis 



This work was financially supported by Zhejiang Provincial Program for Medical and Health Science Co-sponsored by Province and Ministry (grant number 2016137996) and the National Key Research and Development Program of China (grant number 2016YFC1100403).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Supplementary material

417_2018_4130_MOESM1_ESM.pdf (131 kb)
ESM 1 (PDF 130 kb)


  1. 1.
    Finsterer J (2003) Ptosis: causes, presentation, and management. Aesthet Plast Surg 27:193–204CrossRefGoogle Scholar
  2. 2.
    Baroody M, Holds JB, Vick VL (2005) Advances in the diagnosis and treatment of ptosis. Curr Opin Ophthalmol 16:351CrossRefGoogle Scholar
  3. 3.
    Ahuero AE, Hatton MP (2010) Eyelid malposition after cataract and refractive surgery. Int Ophthalmol Clin 50:25–36CrossRefGoogle Scholar
  4. 4.
    Paris GL, Quickert MH (1976) Disinsertion of the aponeurosis of the levator palpebrae superioris muscle after cataract extraction. Am J Ophthalmol 81:337–340CrossRefGoogle Scholar
  5. 5.
    Godfrey KJ, Korn BS, Kikkawa DO (2016) Blepharoptosis following ocular surgery. Curr Opin Ophthalmol 27:31–37CrossRefGoogle Scholar
  6. 6.
    Bernardino CR, Rubin PAD (2002) Ptosis after cataract surgery. Semin Ophthalmol 17:144–148CrossRefGoogle Scholar
  7. 7.
    Mehat MS, Sood V, Madge S (2012) Blepharoptosis following anterior segment surgery: a new theory for an old problem. Orbit 31:274–278CrossRefGoogle Scholar
  8. 8.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341CrossRefGoogle Scholar
  9. 9.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefGoogle Scholar
  10. 10.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefGoogle Scholar
  11. 11.
    Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406CrossRefGoogle Scholar
  12. 12.
    Higgins JPT, Thompson SG, Deeks JJ, Altma DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRefGoogle Scholar
  13. 13.
    Park A, Eliassi-Rad B, Desai M (2017) Ptosis after glaucoma surgery. Clin Ophthalmol 11:1483–1489CrossRefGoogle Scholar
  14. 14.
    Naruo-Tsuchisaka A, Maruyama K, Arimoto G, Goto H (2015) Incidence of postoperative ptosis following trabeculectomy with mitomycin C. J Glaucoma 24:417–420CrossRefGoogle Scholar
  15. 15.
    Koh V, Tatsios J, Chew P, Amrith S (2015) Comparison of incidence of ptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification. Indian J Ophthalmol 63:895–898CrossRefGoogle Scholar
  16. 16.
    Puvanachandra N, Hustler A, Seah LL, Tyers AG (2010) The incidence of ptosis following extracapsular and phacoemulsification surgery: comparison of two prospective studies and review of the literature. Orbit 29:321–323CrossRefGoogle Scholar
  17. 17.
    Besharati MR, Lotfi MH, Nourani F (2008) Outcomes and complications of strabismus surgery in Yazd, Iran. Int J Ophthalmol-Chi 8:1104–1107Google Scholar
  18. 18.
    Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE (2005) Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 140:16–22CrossRefGoogle Scholar
  19. 19.
    Altieri M, EKingston AT, Bertagno R, Altieri G (2005) Ptosis secondary to anterior segment surgery and its repair in a two-year follow-up study. Ophthalmologica 219:129–135CrossRefGoogle Scholar
  20. 20.
    Patel JI, Blount M, Jones C (2002) Surgical blepharoptosis—the bridle suture factor? Eye 16:535–537CrossRefGoogle Scholar
  21. 21.
    Sundar KS, Deshpande M, Gurunadh VS, Palit MG, Baijal V (1999) Evaluation of ocular deviations and ptosis after cataract surgery. Med J Armed Forces India 55:3–5CrossRefGoogle Scholar
  22. 22.
    Singh SK, Sekhar GC, Gupta S (1997) Etiology of ptosis after cataract surgery. J Cataract Refract Surg 22:1409–1413CrossRefGoogle Scholar
  23. 23.
    Song MS, Shin DH, Spoor TC (1996) Incidence of ptosis following trabeculectomy: a comparative study. Korean J Ophthalmol 10:97–103CrossRefGoogle Scholar
  24. 24.
    Feibel RM, Custer PL, Gordon MO (1993) Postcataract ptosis. A randomized, double-masked comparison of peribulbar and retrobulbar anesthesia. Ophthalmology 100:660–665CrossRefGoogle Scholar
  25. 25.
    Loeffler M, Solomon LD, Renaud M (1990) Postcataract extraction ptosis: effect of the bridle suture. J Cataract Refract Surg 16:501–504CrossRefGoogle Scholar
  26. 26.
    Deady JP, Price NJ, Sutton GA (1989) Ptosis following cataract and trabeculectomy surgery. Brit J Ophthalmol 73:283–285CrossRefGoogle Scholar
  27. 27.
    Linberg JV, McDonald MB, Safir A, Goole JM (1986) Ptosis following radial keratotomy: performed using a rigid eyelid speculum. Ophthalmology 93:1509–1512CrossRefGoogle Scholar
  28. 28.
    Kaplan LJ, Jaffe NS, Clayman HM (1985) Ptosis and cataract surgery. A multivariant computer analysis of a prospective study. Ophthalmology 92:237–242CrossRefGoogle Scholar
  29. 29.
    Cheng ACK, Young AL, Law RWK, Lam DSC (2004) Ptosis after laser in situ keratomileusis. J Cataract Refract Surg 30:1572–1574CrossRefGoogle Scholar
  30. 30.
    Rainin EA, Carlson BM (1985) Postoperative diplopia and ptosis: a clinical hypothesis based on the myotoxicity of local anesthetics. Arch Ophthalmol 103:1337–1339CrossRefGoogle Scholar
  31. 31.
    Crosby NJ, Shepherd D, Murray A (2013) Mechanical testing of lid speculae and relationship to postoperative ptosis. Eye 27:1098–1101CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology, College of MedicineThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina

Personalised recommendations