Preoperative Visual Field Patterns Associated with Selection for Concurrent Eyelid and Brow Ptosis Repair

INTRODUCTION: Determining when to perform combined eyelid and brow surgery for functional deficits remains subjective, despite measurable visual field (VF) impairment in affected patients. OBJECTIVES: We sought to identify VF patterns associated with selection for combined eyelid-brow surgery. STUDY DESIGN: Retrospective cohort study Methods: Patients with preoperative Humphrey Visual Field testing undergoing isolated eyelid surgery or combined eyelid-brow surgery for VF deficits were matched 1:2 by demographic and surgical characteristics. VF patterns were analyzed using generalized estimating equations. RESULTS: Among 171 patients, the mid-temporal VF zone was the only independent predictor of combined-repair selection on multivariable analysis (OR=1.38 per dot missed, 95% CI 1.06-1.81, p=0.018). Combined repair was also independently associated with lower odds of need for revision surgery (OR=0.31, 95% CI 0.10-0.97, p=0.044). CONCLUSIONS: The mid-temporal VF may serve as a marker of brow-related visual obstruction, helping guide selection for combined eyelid-brow surgery in functional blepharoptosis.