This is a retrospective review examining the effect of prior topical steroid use on patients undergoing ptosis surgery. Out of a total of 406 eyelids undergoing ptosis repairs, 44 had received topical steroids for an average of 3.7 years prior to surgery. The preoperative levator function was significantly less in the steroid group, 9.8mm versus 10.4mm, and the ptosis significantly worse with margin reflex distances of 0.2mm and 0.58mm respectively. The steroid group were more likely to have recurrent ptosis, but only in those undergoing a levator resection (41% steroid group versus 18% of the non-steroid group). There was no significant difference in those who underwent a Muller’s muscle resection, and these patients had far lower recurrence rates in both steroid and non-steroid groups (12% and 9% respectively). The authors suggest that topical steroids may have induced a myopathy in the levator with Muller’s muscle being relatively spared as it is sympathetically innervated. However, there is no explanation given for the higher recurrence rate in the non-steroid group of those who had levator resections compared to Muller’s muscle resections, suggesting that surgical technique may be an additional important factor. Despite this, the recommendation to warn ptosis patients of the additional risk presented by being on steroids is valid.