Upper Eyelid Blepharoptosis Correction Performed Under the Operating Microscope

Background

Eyelid blepharoptosis correction is commonly performed with loupe magnification. The posture in which this operation is performed, with cervical spine flexion and forward lean, places significant stress on the cervical spine.

Objectives

Performing upper eyelid surgery under the operating microscope is not commonly practiced. The benefits are significantly better surgeon’s posture while operating and potential improved surgical outcomes. These ergonomic and outcome measures were examined in this prospective study.

Methods

From the June 2023 to June 2024, 86 cases of bilateral ptosis correction were performed (172 eyelids) with the microscope.

Results

The mean duration of surgery was 115 minutes for bilateral ptosis correction. Our revision rate was 3%. We found the following surgical advantages with this approach: (1) Superior visual clarity with a higher and adjustable magnification and (2) consistent confocal illumination of the operative field, (3) improved precision of dissection, (4) hemostasis and (5) clear distinction of fine anatomical structures crucial to reconstructive success. The postoperative recovery was faster with better functional and cosmetic outcomes as bruising and edema was minimized from less induction of surgical trauma. Importantly as well, for the surgeon, the operating microscope may extend the longevity of one’s surgical career. The postural ergonomics and cervical unloading afforded by the operating microscope can mitigate cervical spine stress and injury

Conclusions

We found 2 compelling benefits with this approach. Firstly, the surgical outcomes were superior. Secondly, the surgeon’s posture is upright while operating. This long-term benefits of this could not be overstated in preventing cervical spine injuries.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266.