Revisiting Our Prior Hypothesis:

Objectives: To investigate whether changes in the traction of the lower eyelid retractors (LER) after blepharoptosis surgery affect the depth of the inferior conjunctival fornix and whether this is associated with changes in conjunctivochalasis (CCh). Methods: This prospective study included 40 eyes from 20 patients who underwent levator advancement surgery. The severity of CCh and fornix depth were assessed preoperatively and at ≥6 weeks postoperatively in nasal, central, and temporal regions. The distances from the corneal light reflex (center of the pupil) to the upper and lower eyelid margins (MRD-1 and MRD-2, respectively) were also measured. Results: No significant postoperative differences in CCh grade were observed in any region. Fornix depth was significantly increased in the nasal and central regions ( P =0.003 and 0.001, respectively). However, the degree of change in fornix depth did not differ significantly among eyes with worsened, improved, or unchanged CCh. Similarly, no significant differences in MRD-1 or MRD-2 were observed between the improved and unchanged CCh groups. Conclusion: Although fornix depth increased postoperatively in the nasal and central regions, these changes were not associated with CCh progression. This study refutes our previous hypothesis by suggesting that changes in LER traction and fornix depth are not major contributors to postoperative CCh in elderly patients.