Prospective Analysis of Blink Dynamics and Ocular Surface Changes After Levator Aponeurosis Advancement.

PURPOSE: To prospectively evaluate changes in blink dynamics following unilateral ptosis surgery and to assess their relationship with ocular surface parameters. METHODS: Sixteen patients (10 female, 6 male; mean age 56.0 ± 13.2 years) undergoing unilateral levator aponeurosis advancement were enrolled. Incomplete blink percentage and blink rate were assessed using slow-motion smartphone videography. Noninvasive tear break-up time, meibomian gland area loss, palpebral fissure height, and margin reflex distance 1 were measured bilaterally at baseline and at a postoperative visit between day 45 and 60. Ocular surface symptoms were assessed with the Ocular Surface Disease Index. RESULTS: Incomplete blink percentage increased markedly in the operated eye following surgery (12.0% [0.0-50.8] vs. 67.5% [49.0-90.0], p = 0.001), with patients demonstrating ≥50% incomplete blink rates rising from 37.5% to 75.0%. Meibomian gland area loss also increased significantly (29.2% [17.9-42.1] vs. 36.9% [24.9-47.0], p = 0.016). Blink rate, noninvasive tear break-up time, and Ocular Surface Disease Index did not change significantly. No eye-specific parameter changed in the contralateral eye. A negative correlation was found between preoperative incomplete blink percentage and magnitude of postoperative change (r = -0.606, p = 0.013). CONCLUSIONS: Levator aponeurosis advancement produces a marked and selective increase in incomplete blink percentage accompanied by increased meibomian gland area loss, without affecting blink rate or the contralateral eye. Blink incompleteness may represent a clinically underrecognized consequence of ptosis surgery with long-term ocular surface implications.