Association of Upper Eyelid Ptosis Repair and Blepharoplasty With Headache-Related Quality of Life

Importance Headache can be a functional indication for ptosis repair and blepharoplasty. Objective To evaluate the changes in headache-related quality of life in patients who underwent upper eyelid ptosis repair or blepharoplasty. Design, Setting, and Participants A prospective cohort study was conducted among 108 patients who underwent standard upper eyelid blepharoplasty and 44 patients who underwent ptosis repair (levator resection, Müller muscle resection, or frontalis suspension) for obscuration of the superior visual field at an ophthalmology clinic’s oculoplastic department from September 1, 2014, to September 1, 2015. A validated headache-related quality-of-life survey, the Headache Impact Test-6 (HIT), was administered preoperatively and postoperatively to patients who had tension-type headache. The minimum time interval after the operation was 3 months (mean, 13.5 weeks; range, 12-17 weeks). Main Outcomes and Measures Postoperative HIT scores, decline in HIT scores, and marginal reflex distance test 1 scores. Results Of the 108 patients (66 women and 42 men; mean [SD] age, 49.8 [10.7] years) who underwent blepharoplasty and the 44 patients (26 women and 18 men; mean [SD] age, 45.6 [17.8] years) who underwent ptosis repair, 38 (35.2%) and 28 (63.6%), respectively, had symptoms of tension-type headaches. In both groups, the mean (SD) postoperative HIT scores were statistically significantly better than the preoperative HIT scores (blepharoplasty group: preoperative score, 55.9 [6.6] vs postoperative score, 46.4 [9.0]; ptosis repair group: preoperative score, 60.0 [7.2] vs postoperative score, 42.3 [9.3]; P = .001). In the patients who underwent ptosis repair, the mean (SD) preoperative HIT score was significantly higher than in those who underwent blepharoplasty (60.0 [7.2] vs 55.9 [6.6]; P = .007) and the postoperative HIT score was significantly lower than those who underwent blepharoplasty (42.3 [9.3] vs 46.4 [9.0]; P = .03). The mean (SD) decline in the HIT score was significantly higher in patients who underwent ptosis repair than in those who underwent blepharoplasty (17.8 [9.9] vs 9.5 [8.6]; P = .002). For patients who underwent ptosis repair, there was a statistically significant negative correlation between the results on the marginal reflex distance test 1 (median, 1.82; minimum, 1.0; maximum, 3.5) and change in the HIT score (median, 18; minimum, 0; maximum, 30) (P = .005; r = –0.645). In patients who underwent ptosis repair, the mean (SD) difference between the preoperative and postoperative HIT scores was significantly higher for the patients who underwent levator resection (3.1 [0.3]) than for those who underwent Müller muscle resection (1.5 [0.7]) and frontalis suspension procedures (1.9 [0.7]) (P = .001). Conclusions and Relevance The operations for ptosis and blepharoptosis provide significant relief for tension-type headache and result in improved headache-related quality of life. As a result, tension-type headache can be a functional indication for upper eyelid blepharoplasty and ptosis repair, especially for patients with lower results on the marginal reflex distance test 1. Level of Evidence 3.