The Changes in Tear Film and Ocular Surface Associated with Lagophthalmos after Frontalis Suspension

ABSTRACT

PURPOSE: We investigated the incidence of exposure keratopathy, cornea protective changes in tear film such as corneal sensitivity, tear film stability, and tear secretion after frontalis suspension, and the correlation of these with lagophthalmos. METHODS: The corneal sensitivity test, tear film break-up time (tBUT) measurement, and basic secretion test were performed prospectively in patients who had undergone frontalis suspension. RESULTS: The mean lagophthalmos was highest at postoperative 1 week and then gradually decreased. There were no significant changes in corneal sensitivity, tBUT or tear secretion after surgery. No significant differences were found in those parameters between eyes with lagophthalmos of 3 mm or more and those less than 3 mm, nor did these parameters differ between eyes with clear cornea and exposure keratopathy. Only tBUT at postoperative 1 week was significantly shorter in eyes with lagophthalmos 3 mm or more than those less than 3 mm. The average level of lagophthalmos in eyes with exposure keratopathy (15/33 eyes, 45.4%) was more than 3mm at every follow-up period, which was significantly higher than for eyes with a clear cornea. CONCLUSIONS: Tear physiology tends to maintain normal function despite poor blinking induced by lagophthalmos. The cornea is thought to be protected by these functions of tear film. The factor most influential on cornea status was the level of lagophthalmos, and exposure keratopathy should be carefully examined during postoperative period in eyes with higher lagophthalmos, especially more than 3 mm.