Exposure keratopathy following silicone frontalis suspension in adult neuro- and myogenic ptosis

Purpose: To evaluate the incidence of exposure keratopathy following silicone frontalis suspension in adult neuro- and myogenic blepharoptosis. Method: Retrospective noncomparative analysis of the charts of 69 cases (101 eyelids) of silicone frontalis suspension. Results: Sixty-one patients (93 eyelids) had myogenic ptosis, and eight patients (eight eyelids) had neurogenic ptosis. Preoperative diagnoses included chronic progressive external ophthalmoplegia, myotonic dystrophy, oculopharyngeal dystrophy, third cranial nerve palsy because of trauma or other causes. Average age at the time of operation was 54. Mean interval between the intervention and the first and second postoperative control was 8 and 28 months, respectively. Thirty-one patients (31 eyelids) needed a second follow-up visit. Postoperative punctate epithelial erosions (PEE) were encountered most frequently in patients with Steinert's disease (42% of eyes) and congenital ptosis (33% of eyes). Patients with oculopharyngeal dystrophy did not develop PEE. Corneal ulceration developed in three eyes (two patients): one eye was successfully treated with local antibiotic ointments and lubricants, a bilateral corneal ulceration in the second patient was successfully treated with partial conjunctival grafts. Conclusion: This study cohort demonstrated a 26% risk of exposure keratopathy following silicone frontalis suspension. The risk of major corneal complications, such as ulceration, was low (3%).