What Are the Risks of OPMD Ptosis Surgery?

Deciding whether to undergo surgery for drooping eyelids (ptosis) caused by Oculopharyngeal Muscular Dystrophy (OPMD) is a deeply personal choice that requires weighing improved vision against significant surgical risks. Eyelid surgery carries a high risk of postoperative complications, most notably lagophthalmos—the inability to fully close the eyes ^[1]. Because OPMD is a progressive muscle disease, many patients will not be able to close their eyes completely after surgery, which requires daily management to prevent eye damage. Additionally, the progressive nature of the disease means that surgical results are often not permanent, and ptosis may eventually return over time.

The Core Trade-Off: Lifting vs. Closing

Eyelid surgery for OPMD is essentially a balancing act between clearing your visual field and protecting the health of your eye.

• Lifting the lid: The goal of surgery is to raise the eyelid so you can see without having to tilt your head back.
• Closing the lid: Your eye relies on blinking and full closure during sleep to stay lubricated and protected.

In OPMD, the disease weakens the levator muscle (which opens the eye) and Müller’s muscle, which are commonly involved in the dystrophic process ^[2]. Crucially, OPMD can also weaken the orbicularis oculi, the muscle responsible for squeezing the eye shut ^[1]. If a surgeon lifts the eyelid too high, your weakened closing muscles may not be strong enough to overcome the new height, leaving a gap when you try to close your eyes.

Before any surgery, your oculoplastic surgeon will thoroughly test your closing strength and eye movements to assess your personal risk level and determine if surgery is a safe option for you.

Specific Risks of OPMD Ptosis Surgery

Lagophthalmos and Exposure Keratopathy
The most significant risk following ptosis repair in OPMD is incomplete eyelid closure ^[1]. When the eye cannot close completely, the clear front surface of the eye (the cornea) is constantly exposed to air. This can lead to exposure keratopathy, a condition where the cornea becomes severely dry, inflamed, or physically damaged (ulcerated) ^[1].

Severe Dry Eye
Because of the risk of exposure, patients frequently experience chronic dry eye after surgery. You will likely need to use artificial tear drops frequently during the day and thick lubricating ointments at night, potentially for the rest of your life.

Ophthalmoplegia
OPMD can cause ophthalmoplegia, or weakness in the muscles that move the eye itself ^[1]. Normally, when you close your eyes or sleep, your eyeball naturally rolls upward—a protective reflex called Bell’s phenomenon. If OPMD has weakened your eye movements, your eye may not roll up, leaving the sensitive cornea directly exposed in the gap of the partially open eyelids ^[3].

How Surgeons Manage These Risks

Because the risk of severe ocular complications is high ^[1], oculoplastic surgeons employ several strategies to protect your eyes:

• Intentional Under-correction: Rather than aiming for perfect cosmetic symmetry or the maximum possible lift, surgeons often intentionally “under-correct” the droop ^[1]. This means the eyelid will still droop slightly, but you will have a much better chance of protecting your cornea. The priority is preserving the health of the eye over achieving a flawless appearance.
• Choosing the Right Surgical Technique: Because OPMD is progressive, the choice of procedure is highly individualized ^[4]. Two common approaches include:
  • Frontalis Sling: This involves using a material (often a silicone band) to connect the eyelid to the forehead muscle (frontalis). When you raise your eyebrows, it lifts the eyelids. This requires that your forehead muscles are still relatively strong. Silicone slings are often preferred because they are somewhat elastic and can sometimes be adjusted or removed if severe dry eye develops ^[1].
  • Levator Resection/Advancement: This involves shortening the muscle that lifts the eyelid. However, because this muscle is directly affected by the dystrophic process in OPMD ^[2], its effectiveness and risks must be carefully evaluated.
• Temporary Tarsorrhaphy: If severe lagophthalmos and corneal damage occur after surgery, surgeons have emergency backup plans. A drawstring tarsorrhaphy is a technique where the surgeon temporarily sews the corners of the eyelids partially shut to protect the eye while it heals and adjusts ^[1].

Non-Surgical Alternatives

If you and your doctor decide that the surgical risks are currently too high, there are non-surgical alternatives to help manage ptosis. You can use specialized eyelid tape to manually hold the lids up during the day. Another option is “ptosis crutches”—small wire attachments added to the inside of prescription glasses frames that physically prop the eyelids open.

Ultimately, deciding on surgery involves weighing the very real benefits of clearing your vision against the high risk of needing ongoing, daily medical management for a dry, exposed eye.