The Effect of Conjunctiva-Müller Muscle Resection on Tear Oxidative Stress Levels in Patients with Blepharoptosis

Objectives: To examine changes in tear oxidative stress levels and tear film functions in patients with blepharoptosis and dermatochalasis following conjunctiva-Müller muscle resection (CMMR) and blepharoplasty surgeries. Materials and Methods: This prospective study included 32 healthy controls and 62 patients with blepharoptosis or dermatochalasis. CMMR surgery was performed in 20 eyes and upper blepharoplasty was performed in 42 eyes. Tear oxidative stress markers (8-hydroxy-2'-deoxyguanosine [8-OHdG] and 4-hydroxy-2-nonenal [4-HNE]) were quantified by enzyme-linked immunosorbent assay and tear film functions were evaluated preoperatively and at 1 and 6 months postoperatively. The same assessments were performed in the control group at the same time points. Results: Preoperative tear 8-OHdG and 4-HNE levels were lower in healthy controls (52.8±13.5 ng/mL and 27.8±6.4 ng/mL, respectively) compared to patients with dermatochalasis (86.1±37.2 ng/mL and 29.8±11.1 ng/mL, respectively) and blepharoptosis (90.4±39.3 ng/mL and 43.1±4.2 ng/mL, respectively) (p<0.001). 8-OHdG levels were increased at 1 month after CMMR, while both markers were decreased 1 month postoperatively in the blepharoplasty group (p=0.034). Schirmer 1 and OSDI scores did not change throughout the visits in both patient groups, but a temporary decrease in tear break-up time (TBUT) was observed after CMMR (p=0.017). Conclusion: Dermatochalasis and blepharoptosis were associated with higher tear oxidative stress levels. CMMR surgery caused a temporary decrease in TBUT scores and an increase in oxidative stress in the first postoperative month.

Effect of Ptosis Surgery on Tear Oxidative Stress Levels in Patients with Blepharoptosis and Pseudoptosis.

Objectives: Investigation of the surgical correction effect on tear film functions and tear oxidative stress levels in patients with blepharoptosis and pseudoptosis. Methods: Sixty patients with blepharoptosis or pseudoptosis due to dermatochalasis and 30 healthy controls were included in the study. Forty eyes underwent upper blepharoplasty and 20 eyes underwent levator surgery. The tear oxidative stress levels (8-hydroxydeoxyguanosine [8-OHdG] and 4-hydroxy-2-nonenal [4-HNE]) were determined by enzyme-linked immunosorbent assay and tear film functions were evaluated pre-operatively and at the post-operative 1st and 6th months. Results: 8-OHdG and 4-HNE levels in tears were found higher in patients with dermatochalasis (86.3±38.2 ng/mL; 29.8±11.4 ng/mL, respectively) and blepharoptosis (95.3±43.8 ng/mL; 40.8±3.8 ng/mL, respectively) compared to healthy controls (52.9±14.0 ng/mL; 27.8±6.6 ng/mL, respectively). Both levels decreased 1 month after blepharoplasty surgery. The 8-OHdG level in tears of patients who underwent levator surgery increased 1 month after the surgery (p=0.008). No change was detected in tear function tests findings between visits in any patient group. Conclusion: Dermatochalasis and blepharoptosis may lead to an increase in the tear oxidative stress levels. Contrary to a decrease in these levels after blepharoplasty, they may increase in the early period after levator surgery followed by a return to normal levels at the 6th-month visit.