Transient Refractive Shift Following Ptosis Surgery In A Stable Post-Lasik Eye: Evidence Of Mechanically Induced Epithelial Remodelling
Published 2026 - 44th Congress of the ESCRS
Reference: CC02.08 | Type: Case Report | DOI: 10.82333/sw3p-vj98
Authors: Mr Vimal Piparia* 1 , Prof. Dan Reinstein 2 , Dr Timothy Archer 1 , Mr Joseph Potter 1 , Ms Ruchi Gupta 1
1London Vision Clinic,London ,United Kingdom, 2London Vision Clinic,London ,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom
Purpose
To describe the characteristics of refractive shift following eyelid surgery in a stable post-LASIK patient, and to explore the associated corneal remodelling and biomechanical changes that may contribute to this phenomenon.
Setting
Private Practice Academic Unit Reinstein Vision, London Vision Clinic, EuroEyes Group, UK
Report of case
A 69-year-old male underwent LASIK Laser Blended Vision (LBV) nine years prior, with the dominant right eye for distance and non-dominant left eye for near. He presented for retreatment after noticing reduced visual quality following bilateral ptosis surgery 11 weeks earlier. Manifest refraction changed from +0.25 -0.25 × 78 to 0.00 -1.00 × 100 in the right eye and from -1.75 -0.75 × 80 to -1.00 -1.25 × 110 in the left. Slit-lamp exam showed a quiet ocular surface with no lens opacity. MS-39 anterior segment OCT mapping revealed asymmetric epithelial redistribution without stromal thinning, posterior elevation changes, or ectatic features. The refractive shift and epithelial remodeling were attributed to altered mechanical forces from ptosis surgery rather than intrinsic corneal disease. At 5-month follow-up, manifest refraction returned to baseline (right eye: +0.25 -0.50 × 80; left eye: -1.75 -0.50 × 98) with restoration of uncorrected visual performance. Repeat OCT showed normalization of epithelial thickness with a symmetric profile, stable stromal thickness, unchanged posterior elevation, and no tomographic progression. Corneal curvature returned to baseline, with no biomechanical decompensation or ectatic evolution. Spontaneous resolution of refractive and epithelial changes supports a transient, mechanically induced corneal response rather than intrinsic instability.
Conclusion/Take home message
This case illustrates that eyelid surgery may induce transient refractive change in previously stable post-LASIK eyes through temporary epithelial remodelling, likely mediated by altered periocular biomechanics. It highlights the importance of epithelial thickness mapping prior to considering corneal retreatment in patients presenting with refractive instability following periocular surgery.