Upper lid ptosis surgery: what is the optimal interval for the postoperative review? A retrospective review of 300 cases.

PurposeCorrection of upper eyelid ptosis is one of the most commonly performed oculoplastic procedures on the NHS but there is currently no data in the literature informing the surgeon of the optimal time for the first postoperative review. Our aim was to investigate how often a complication that warranted intervention occurred in the first 6 weeks after surgery and whether such a complication could have been predicted preoperatively.Patients and methodsA retrospective review was performed of 300 operations in 239 patients over a 9-month period at Moorfields Eye Hospital, London. Electronic medical record software was used to extract data regarding the timing of first postoperative review, complications, any return to theatre, and any underlying risk factors or co-morbidities.ResultsAt 1 week 44 % (133) cases were reviewed, 30% (89) at 2 weeks, 17% (50) at 3 weeks, and 9% (28) at 4 or more weeks. The overall complication rate at any time during the 6-week follow-up interval was 8%. The majority of these complications were minor (24 eyes, 8%) and 1 was major (0.3%). Of the 25 complications, an underlying risk factor was identified in 14 cases.ConclusionsThese data indicate that postoperative complications are very low in the absence of preoperative risk factors. In our institution, as the risk of overcorrection is low, most patients without risk factors for exposure (51% in this series) can safely be reviewed later than 1 week after surgery, but for those with risk factors earlier follow-up is warranted.

Medically unexplained visual symptoms in children and adolescents: an indicator of abuse or adversity?

PURPOSE: To highlight abuse and adversity in childhood as an association of medically unexplained symptoms. METHODS: Case series. RESULTS: Two young adults and one child (all female) are described with medically unexplained impaired vision and diplopia, which on further investigation were found to be associated with abuse or adversity, and in one case was followed by the development of further unexplained symptoms. CONCLUSIONS: Ophthalmologists dealing with children and young people need to ensure that child abuse and adversity are considered as potential underlying associations when dealing with patients with medically unexplained symptoms.