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 conducted at Sindh Institute of Ophthalmology and Visual Sciences (SIOVS) over a six-month period. Overall 52 patients aged 30–50 years diagnosed with aponeurotic or simple congenital blepharoptosis with good levator function were included. Patients were equally divided into two groups: LA and GA. Outcomes were assessed based on Margin Reflex Distance-1 (MRD-1), eyelid symmetry, intraoperative adjustability, patient satisfaction, and complications. Follow-ups were conducted weekly during the first month and monthly thereafter. SPSS version 26 was used for data entry and analysis.
Results: Mean postoperative MRD1 was 3.4 ± 0.6 mm in LA group versus 2.9 ± 0.7 mm in GA groups (p=0.012), indicating better eyelid height correction with local anesthesia. Surgical success was achieved in 46/52 (88.5%) patients in LA group compared to (73.2%) in GA group (p=0.038). Undercorrection occurred in (5.8%) of LA versus (16.1%) of GA group (p=0.041), while overcorrection rates were comparable between groups (5.8% vs 7.1%, p=0.62). Mean operative time was slightly longer in LA groups than GA group (p=0.045), while postoperative complication rates did not differ significantly between groups (9.6% vs 12.5%, (p=0.51).
Conclusion: Levator resection under local anesthesia demonstrates superior functional and cosmetic outcomes compared to general anesthesia and should be preferred when feasible, along with better (MRD1), higher surgical success rates, and lower undercorrection rates.