Adult-onset exposure keratitis after childhood ptosis repair with frontalis sling procedure.

OBJECTIVE

To report the development of adult-onset exposure keratitis in patients having undergone childhood ptosis repair with frontalis sling surgery (FSS).

STUDY

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Seven patients having received childhood FSS who were referred to us as adults with a complaint of ocular dryness that did not develop until years after surgery.

METHODS

Single-centre, clinic-based, chart review.

RESULTS

Four patients had bilateral, congenital ptosis and 3 had unilateral ptosis, secondary to childhood trauma (2) and third nerve palsy (1). Mean age at first FSS was 6 years (range, 9 months-14 years). Five patients had received additional ophthalmic surgery, including strabismus surgery (2), repeat FSS (4), and prior failed levator resection (1). Mean age at referral to our centre with complaint of ocular dryness was 37 years (range, 23-46 years). Mean time from most recent FSS to presentation was 23 years (range, 17-36 years). On examination, 6 patients had related eyelid abnormalities, including bilateral entropion (1), ptosis recurrence (4), and peaked upper eyelid (1). All patients had measurable lagophthalmos (range, 0.5 mm-3 mm), and 5 had detectable punctate keratopathy (range, "trace" to "2+" on a scale of 0 to 4+). All patients were offered artificial lubricating drops, and 3 were deemed candidates for corrective eyelid surgery, resulting in improvement of exposure keratitis.

CONCLUSIONS

Adult-onset exposure keratitis should be included as a potential late complication of FSS ptosis repair in children, particularly when multiple surgeries are required or complications occur.