Changes to refractive error after surgery for congenital ptosis
Reviewed by Fiona Rowe

In this study, the authors examined surgically induced refractive changes and changes in visual acuity after congenital ptosis surgery for 24 patients (16 males, 8 females) with age at surgery of 1.82 ±3.48 years and time from diagnosis to surgery of 181 ±488 days. Time from surgery to last follow-up was 874 ±765 days. Ptosis was bilateral for 8 patients, left-sided for 11 and right for 5 patients. Surgery included frontalis suspension in 18, levator resection in 3, Mullers muscle-conjunctival resection in 2 and levator advancement in 1. Postoperatively there was a non-significant improvement of visual acuity of the operated eye. At follow-up, 4 patients had amblyopia; 2 from preoperative and 2 new cases, the latter having significant residual ptosis requiring a second surgery. There was a significant induced refraction change with mean change in the operated eye of 0.6+0.7x84.2. Mean change of the non-operated eye was 0.3+0.7x80. Postoperatively, 19 had astigmatism, 5 hypermetropia, 1 myopia and 2 anisometropia. The patients having frontalis suspension needed more additional surgery than other procedures (55.6% vs 16.7%). Therefore, the authors suggest frontalis suspension is reserved for patients not suited to other surgical procedures. The results support the occurrence of refractive changes after ptosis surgery. Age-related differences were also found. For children <1 year of age, modest changes were found with mild mean changes. For ages 1–3 years, there was greater variability and these carried the highest risk for amblyopia. For ages 3–6 years, there were smaller refractive changes indicating greater stability, and for those >6 years, there were high rates of changes. Hence, children, particularly younger ages, need refractive monitoring before and after surgery.

Refractive changes following congenital ptosis surgery.
Watad M, Masalha M, Wygnanski-Jaffe T, et al. 
STRABISMUS
2026;34(2):163–9.