Three Different Anesthesia Approaches in Blepharoptosis Surgery

Ziyi Guo, MD; David Dae Hwan Park, MD, PhD; Kisoo Park, MD; Naiqiang Guo, MD


Plast Reconstr Surg Glob Open. 2019;7(4):e2136 

In This Article

Abstract and Introduction


Background: Despite the many methods of anesthesia for blepharoptosis, there is little documentation in the literature. When using the Müller aponeurosis composite flap advancement approach, one of the 3 anesthesia methods is chosen: general, local, and sedative anesthesia. On the other hand, the choice of anesthesia method is controversial.

Methods: A total of 101 patients (48 female and 53 male) admitted to hospital for treatment were selected: 38 (37.6%) patients (49 eyes) with local anesthesia, 34 (33.7%) patients (60 eyes) with general anesthesia, and 29 (28.7%) patients (42 eyes) with sedative anesthesia.

Results: The preoperative average marginal reflex distance (MRD1) in the local, general, and sedative anesthesia groups was 0.90, 0.35, and 0.47 mm, respectively. The corneal exposure area (CEA) in the local, general, and sedative approach groups was 63.2%, 57.8%, and 55.9%, respectively. The postoperative average distance for the MRD1 was significantly different among the 3 anesthesia approaches. The postoperative MRD1 in the local approach group was 3.28 mm and the CEA improved to 75.4%. In the general anesthesia approach group, the MRD1 was 3.01 mm and the CEA was 73.4%. In the sedative anesthesia approach group, the MRD1 and CEA were 3.62 mm and 74.0%, respectively. The MRD1 in the general, local, and sedative groups was 2.65 ± 1.48, 2.39 ± 1.65, and 3.17 ± 1.77, respectively; the difference was not significant (P > 0.05).

Conclusions: The general, local, and sedative anesthesia approaches are all effective in the correction of blepharoptosis; the results were similar regardless of the anesthesia approach. On the other hand, the patients felt more comfortable and surgeons could control the process more easily using the sedative approach.


Ptosis can be classified as congenital or acquired, where 70% of congenital diagnoses present as unilateral or bilateral disorders of the upper eyelids.[6]

Treatments of blepharoptosis have been under development for 100 years and are still being refined. Essentially, the method for selecting the appropriate blepharoptosis treatment has been well documented and more surgeons choose to use the Müller aponeurosis composite flap advancement technique.[9] Many factors affect the surgical outcomes, one of which is the choice of suitable anesthesia approach. Because there has been little research on anesthesia approaches for blepharoptosis treatment, the method for selecting the appropriate anesthesia approach for blepharoptosis treatment is based only on the severity of ptosis, and the surgeon's personal skill and experience. This article focuses on the outcomes of 3 different anesthesia approaches, as well as the advantages and disadvantages of the approaches when performing the procedure.[1,6]