AOA's response regarding published study correlating contact lens wear to developing ptosis

The Aesthetic Surgery Journal published a study titled, "Environmental Factors That Contribute to Upper Eyelid Ptosis: A Study of Identical Twins" on March 24, 2015. The study was in a Yahoo! Health story that reached the general public on June 5, 2015.

Should you or your patients have questions about this item and the study it is referring to, AOA has compiled the following information for your reference.

According to the Yahoo! Health story, the study posits that wearing contact lenses leads to droopy eyelids. The story said researchers reviewed photos of 96 sets of identical twins yearly from 2008 to 2010 in Twinsburg, Ohio and measured their eyelid droopiness.

According to the abstract of the study, the authors assessed environmental factors that may contribute to eyelid ptosis in a population of identical twins. The researchers' final statement after the conclusion was,

Wearing either hard or soft contact lenses was the only environmental factor that we found to be associated with acquired blepharoptosis. No others factors were identified as having a significant impact. The actual mechanism of contact lens-induced ptosis is still poorly understood, although recurrent traction on the eyelid during placement and removal likely leads to changes in the levator aponeurosis and Mueller's muscle. This type of ptosis is amenable to correction using the modified Putterman technique.

Beth Kneib, O.D., Director of the AOA Clinical Resources Group states:

Despite the conclusion of an early paper by Nicholas Satariano, Matthew S. Brown, Samantha Zwiebel, and Bahman Guyuron in the Aesthetic Surgery Journal, March 24, 2015, indicating contact lens wear as the only environmental factor associated with acquired blepharoptosis, further study is needed to identify cause and effect of ptosis and if alternative eyelid manipulation methods of CL insertion make a difference over time. Although this ptosis difference has been reported, there are many positive reasons why patients choose to wear contact lenses for their lifetime and years of improved cosmetic appearance is high on the list.   

Thomas Quinn, O.D., M.S., Chair of the AOA Contact Lens and Cornea Section provides the following information on the topic:
We have known for quite some time that GP (rigid or hard) lenses can lead to mild ptosis1,2. This is thought to be secondary to one of two causes:

A. From stretching of the eyelid structures when employing a "tugging technique" on the eyelids to remove the lenses from the ocular surface

B. Possibly due to chronic, low grade irritation of the upper eyelid from the GP lens edge or surface. 

One strategy GP lens wearers can employ to reduce ptosis is to refrain from employing the "tugging on the eyelids" technique of lens removal, and instead use a DMV suction cup device. Also, wearing a clean lens with a thin, smooth edge should help.

The issue of whether soft lenses can lead to ptosis is less clear, with some studies showing no impact from soft lens wear1 and others showing soft lenses, though less than GP lens, can impact ptosis3,4.

Factors to be aware of when assessing whether a contact lens is causing ptosis include:

A. Is lid position being assessed with lenses in or out? If lenses are in, the effect may be temporary and not a permanent change in eyelid position.

B. Are safeguards taken to guard against squinting? This is important as it may be confused with ptosis.

If soft lenses do indeed promote ptosis, it is speculated that this is a result of infection or inflammation. If this is the case, ensuring the patient is wearing a well-fitted, clean lens is likely to minimize this effect. A daily disposable lens may be the ideal choice as it has been shown to significantly reduce inflammatory ocular events when compared to lenses that are re-worn5.

  1. Fonn D1, Pritchard N, Garnett B, Davids L. Palpebral aperture sizes of rigid and soft contact lens wearers compared with nonwearers. Optom Vis Sci. 1996 Mar;73(3):211-4.
  2. Kitazawa T1. Hard contact lens wear and the risk of acquired blepharoptosis: a case-control study. Eplasty. 2013 Jun 19;13:e30. Print 2013
  3. Bleyen I1, Hiemstra CA, Devogelaere T, van den Bosch WA, Wubbels RJ, Paridaens DA. Not only hard contact lens wear but also soft contact lens wear may be associated with blepharoptosis. Can J Ophthalmol. 2011 Aug;46(4):333-6. doi: 10.1016/j.jcjo.2011.06.010. Epub 2011 Jul 7.
  4. Nemoto Y1, Morikawa K, Kaneko H. [A case of blepharoptosis associated with long-term use of soft contact lenses]. Nihon Ganka Gakkai Zasshi. 2008 Oct;112(10):876-81
  5. Chalmers, Robin L. et al, Multicenter Case-Control Study of the Role of Lens Materials and Care Products on the Development of Corneal Infiltrates, Optometry & Vision Science. 89(3):316-325, March 2012.