Last updated August 2, 2022

Eyelid Surgery for Upper Visual Field Improvement

Summary of Recommendations

The workgroup recommends that for patients presenting with low upper eyelid position, clinicians obtain a clinical history, which should include an assessment of impact on visual field or activities of daily living; and perform a physical examination to assess upper eyelid position (ptosis) relative to the pupil (such as MRD-1) with photographic documentation and assessment of levator function. (M, Moderate)
1986175

The workgroup suggests that surgeons not perform blepharoplasty alone (i.e., without ptosis correction) for patients presenting with diagnosed ptosis or low upper eyelid position. (L, Weak)
1986175

The workgroup suggests that surgeons perform concurrent upper eyelid blepharoplasty and ptosis correction in patients presenting with ptosis and dermatochalasis (excess upper eyelid soft-tissue hooding). (L, Weak)
1986175

The workgroup suggests that surgeons perform upper eyelid blepharoplasty in patients presenting with dermatochalasis (excess upper eyelid soft-tissue hooding) without underlying ptosis. (L, Weak)
1986175

The workgroup recommends that surgeons should perform anterior ptosis correction for patients diagnosed with severe upper eyelid ptosis. (M, Moderate)
1986175

It is an option for surgeons to perform either anterior or posterior ptosis correction for patients diagnosed with mild or moderate upper eyelid ptosis. (M, Option)
1986175

The workgroup suggests that surgeons may use local anesthesia for patients presenting for upper eyelid ptosis correction and/or blepharoplasty. (L, Weak)
1986175

It is an option for surgeons to perform adjunctive brow surgery in patients presenting with dermatochalasis and coexisting brow and upper eyelid ptosis. (L, Option)
1986175

It is an option for surgeons to perform levator plication or levator advancement for patients presenting with upper eyelid ptosis. (VL, Option)
1986175

The workgroup recommends that patients should have an assessment for complications including asymmetry and lagophthalmos within 1–3 mo following the procedure and again ideally at 9 mo to 1 yr for patients who have had upper eyelid ptosis correction and/or blepharoplasty. (M, GP)
1986175

Recommendation Grading

Overview

Title

Eyelid Surgery for Upper Visual Field Improvement

Authoring Organization

Publication Month/Year

August 1, 2022

Document Type

Guideline

Country of Publication

US

Document Objectives

A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D013518 - Surgery, Plastic, D019882 - Blepharoplasty, D005143 - Eyelids

Keywords

plastic surgery, eyelid surgery, vision improvement, blepharoplasty, ptosis

Source Citation

Kim KK, Granick MS, Baum GA, Beninger F, Cahill KV, Donnelly KC, Kaidi AA, Kang AS, Loeding L, Loyo M, Patel PA, Roostaeian J, Taghva GH, Varkarakis GM. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual Field Improvement. Plast Reconstr Surg. 2022 Aug 1;150(2):419e-434e. doi: 10.1097/PRS.0000000000009329. Epub 2022 Jul 27. PMID: 35895522.