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Novel surgical technique may be more effective in treating common eyelid disorder

DALLAS – June 05, 2023 – A novel, minimally invasive surgical technique for correcting blepharoptosis – often called “droopy eyelid” – is more efficient and produces better results than the traditional method that uses sutures, according to a UT Southwestern Medical Center study. The findings, reported in the American Journal of Ophthalmology, may lead to a shift in how oculoplastic surgeons treat this common condition. 

The technique – known as sutureless conjunctiva-sparing Müllerectomy, or sutureless CSM – was pioneered at UT Southwestern in 2019 by Ronald Mancini, M.D., Professor of Ophthalmology.

Clive N. Svendsen, PhD

Ronald Mancini, M.D., is a Professor of Ophthalmology at UT Southwestern.

To determine the procedure’s efficacy, UTSW researchers studied the medical records of 100 patients ages 19 to 87 – some of whom had both eyes corrected – with a minimum follow-up interval of six months.

“Our study found that sutureless CSM is highly effective,” Dr. Mancini said. “Only 2.3% of the patients studied required a second surgery for either undercorrection or overcorrection, and none of the patients experienced a postoperative corneal abrasion or ocular complication.”

Since the 1970s, the standard surgery for blepharoptosis calls for removing a portion of the conjunctiva, the thin membrane on the underside of the eyelid, and then tightening the levator muscle. The incision is secured with sutures. In 2016, Dr. Mancini developed a conjunctiva-sparing surgical approach that involves dissecting and preserving the delicate conjunctiva rather than discarding it as was previously done. The more advanced sutureless CSM not only spares the conjunctiva, but it also relies on cauterization to close the incision, which leads to a more comfortable recovery for the patient.

During the study, researchers used software to analyze preoperative and postoperative patient photographs and relied on two standard measures to evaluate outcomes – the distance from the corneal light reflex to the upper eyelid margin, known as margin reflex distance 1 (MRD1), and palpebral fissure height (PFH), the distance between the central upper and lower eyelid margins.

“We found significant improvement in both MRD1 and PFH and good symmetry in almost all cases,” Dr. Mancini said.

In addition, procedures in the study were completed in an average of 4.42 minutes compared with 8.45 minutes for traditional surgery and required less anesthesia.

Blepharoptosis is one of the most common conditions treated by oculoplastic surgeons. It is often the result of sagging skin or loss of muscle tone due to aging, but it can also be a congenital condition or caused by infection, injury, or nerve damage.

“Blepharoptosis is more than just an aesthetic issue because it can actually affect a patient’s vision,” Dr. Mancini said. “These findings indicate that sutureless CSM may become the new gold standard in care.” 

Other UTSW researchers who contributed to this study are Zachary Keenum, M.D., Assistant Instructor, Phillip Tenzel, M.D., Assistant Professor, and Matthew Petroll, Ph.D., Professor, all from Ophthalmology; and Parsha Forouzan, M.D., a former resident in the department. Dr. Petroll has an additional appointment in Biomedical Engineering.