Blepharoptosis in RGP and PMMA hard contact lens wearers

Contact lens wear has been documented to cause an acquired non-senile blepharoptosis. This is generally associated with prolonged wearing of hard contact lenses. The aim of this study was to determine the clinical features of blepharoptosis associated with contact lens wear including the type of contact lens and the duration of wear.This is a retrospective study of consecutive patients seen over four years (1997 to 2001) in the private practice of an oculoplastic surgeon.A total of 15 consecutive patients presented over the four-year period with blepharoptosis in the context of prolonged contact lens use. Four of the 15 patients (27 per cent) were wearing rigid gas permeable (RGP) lenses. The rest had been wearing PMMA hard lenses. Thirteen patients (87 per cent) had been wearing their contact lenses for more than 17 years. The patients' ages ranged between 15 and 71 years with a mean age of 46 years. All 15 patients had normal levator palpebrae superioris function. Four patients (27 per cent) had bilateral involvement. Eleven patients (73 per cent) underwent ptosis repair where aponeurosis thinning/dehiscence was noted. When compared with patients who presented over the same period with other causes of blepharoptosis (traumatic, myopathic, anophthalmic and involutional), contact lens wear was found to be an uncommon cause of ptosis across all age groups.The majority of contact lens wearers presenting with blepharoptosis gave a history of prolonged use of hard contact lenses. One explanation for this would be the mechanisms of removal of hard contact lenses. This involves pulling the lids laterally at the lateral canthus followed by a harsh blink, which over years can lead to levator aponeurosis dehiscence. Contact lens associated ptosis is an uncommon cause of acquired ptosis across all age groups.