Use of speculum not solely responsible for postoperative ptosis: Study

A recent study explored the potential relationship between the use of speculums during phacoemulsification surgery and the development of blepharoptosis, or eyelid drooping. The findings published in the recent issue of Indian Journal of Ophthalmology journal highlighted the transient nature of postoperative ptosis and underline the influence of various surgical factors beyond speculum use.

The prospective observational study spanned from October 2017 to May 2018 which involved 221 patients (250 eyes) who were undergoing cataract surgery under topical anesthesia. This research measured critical parameters, including Margin Reflex Distance 1 (MRD1), levator palpebrae superioris (LPS) function, and lid crease distance (LCD), before and after surgery at intervals of one day, 1 month, 3 months, and 6 months.

The initial findings revealed that 34 patients developed postoperative ptosis on the first day after surgery. Among these, 15.8% had underwent surgery with a rigid speculum, while 11.4% had used a non-rigid speculum. However, by the one-month follow-up, the number of patients with persistent ptosis significantly dropped to 4 cases. One of these patients had surgery with a rigid speculum, while the other three cases were associated with the use of non-rigid speculums.

The subsequent follow-ups at 3 and 6 months presented promising results, with all cases of ptosis having resolved entirely. This illuminated the transient nature of postoperative eyelid drooping. While speculum use was examined closely, the study found that it could not be solely blamed for postoperative ptosis. Other factors such as superior rectus bridle suturing, anesthetic techniques, prolonged eye patching, and extended surgery durations are believed to contribute to the condition.

The outcomes emphasized that understanding the multifactorial nature of ptosis following phacoemulsification surgery can help in refining surgical techniques and minimizing postoperative complications. Overall, this study provides valuable insights for ophthalmic surgeons and revealed the importance of patient monitoring and comprehensive evaluations to ensure full recovery after cataract surgery. 

Source:

Palanivel, S., Jayagayathri, R., & Yadalla, D. (2025). The impact of speculum uses on the incidence of blepharoptosis in patients undergoing phacoemulsification surgery: A prospective analysis. Indian Journal of Ophthalmology, 73(2), 210–213. https://doi.org/10.4103/ijo.ijo_1476_24