Difference in Surgical Outcomes of Levator Resection Under Local Versus General Anesthesia in Blepharoptosis

Abstract

Objective: To compare the surgical outcomes of levator resection performed under local anesthesia (LA) versus general anesthesia (GA) in patients with Blepharoptosis.

Methodology: This prospective comparative study was done at Sindh Institute of Ophthalmology and Visual Sciences (SIOVS), from May 2025 to October 2025. Patients aged 30 to 50 years old, clinically diagnosed with Blepharoptosis and good levator function (>5 mm) and of either gender were included. Patients were equally divided into two groups based on types of anesthesia (LA and GA). The postoperative outcomes were evaluated over a 3-month follow-up period in terms Margin Reflex Distance-1 (MRD-1), eyelid symmetry, patient satisfaction, and complications, with visits scheduled as on 1st day, 2nd week and on 3rd month after surgery.

Results: Overall the mean postoperative MRD-1 was significantly improved in the LA group at all follow-up points including day one, 2nd weeks, and 3rd months compared to GA group, (3.04mm vs. 2.04 mm), (4.12mm vs. 3.04 mm), and (5.10 vs. 4.03 mm), respectively. (p=0.001), indicating better eyelid height correction with local anesthesia. Symmetry achieved and satisfaction levels were almost similar across the (p >0.05), while under correction (6.0% vs. 10.0%) and overcorrection (6.0% vs. 12.0%) were both lower in the LA group, along with Lagophthalmos was less frequent in the LA group at both the 2nd week (10.0% vs. 16.0%) and 3rd month (0.0% vs. 4.0%). On the other, mean duration of surgery was significantly longer in the LA group (50.96 ± 8.06) minutes compared to GA group (31.48 ± 9.42) minutes, p=0.001.

Conclusion: The LA found to be a safe, effective, and clinically favorable approach for levator resection, in terms of better postoperative MRD-1 correction achievements, along with lower rates of under correction, overcorrection, and lagophthalmos. However, the symmetry achieved and patient satisfaction level remains almost similar across the groups, with significant less mean duration of surgery in GA group.