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The Oculoplastic factor in Cataract Surgery

Many Physicians factor conditions of the lens, cornea and retina when suggesting cataract surgery in older adults.  However, now many other conditions with the eyelid and orbit are also considered and can increase the risk associated with cataract surgery. According to Dr. Jonathan Dutton, M.D. at the University of North Carolina, ptosis repair if mild, does not require repair prior to cataract surgery and is in most cases cosmetic.  If the lid is so low that it is blocking their vision, doing cataract surgery first will have a limited benefit to the patient because the lid will still be in the way. Fixing the ptosis is suggested prior to performing cataract surgery in this instance. In another instance it may be beneficial to perform cataract surgery first then perform the ptosis repair. It has been documented that sometimes, even up to a year after cataract surgery, that upper lid ptosis can occur. Due to the eye speculum pulling the muscles and severing adhesions during the cataract surgery process, some drooping may occur. With ptosis repair in patients with Dry Eye Syndrome contemplating cataract surgery, you must consider conservative correction.  Dry eyes can be very bothersome to the patient and you do not want to make the ptosis repair so severe that the patient is thrown into an even more uncomfortable symptomatic episode of chronic dry eye. Another factor to consider is Dermatochalasis, which is a redundant amount of upper eyelid skin lying over the eye lashes. This condition creates the perfect breeding ground for bacteria to grow and causes chronic Blepharitis. Removing this extra skin prior to cataract surgery can reduce the likelihood of infection after cataract surgery from this condition. As in any decision for surgery, many factors must be considered from the patient and physician standpoint prior to moving forward with cataract surgery in the older adult.  

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