Blepharoptosis and Cholesterol-Lowering Medications: A Retrospective Study

Blepharoptosis and Cholesterol-Lowering Medications: A Retrospective Study: Purpose:

To investigate the prevalence and frequency of patients with blepharoptosis who take anticholesterol therapies. To our knowledge, this is the first large single-center series to evaluate this association.

Methods:

A retrospective chart review of adult patients presenting with ptosis on concomitant anticholesterol medications.

Results:

Two hundred ninety-three adult patients with ptosis taking anticholesterol therapy were identified from October 2011 to October 2016. Forty-seven patients (16.0%) reported muscle weakness. Laboratory markers including creatine kinase (CK) and myoglobin levels were obtained. Of the 47 patients, 13 patients (4.4%) were identified to have ptosis and laboratory confirmed anticholesterol therapy-induced myopathy. Two additional patients with statin-induced myositis and rhabdomyolysis were identified from the period 2008–2011. All patients had measurably elevated CK and/or myoglobin levels. All patients experienced improvement in ptosis or systemic symptoms after discontinuation or changing medications. Nine patients (60%) demonstrated statistically significant improvement in the ptosis.

Conclusions:

Many patients with involutional ptosis also have both cardiovascular disease and hyperlipidemia and thus take cholesterol-lowering medication. Our study demonstrates a World Health Organization-defined probable association between ptosis and anticholesterol-induced myopathy. The frequency of anticholesterol-induced myopathy in adult ptosis was 4.4%, which is substantially higher than previously predicted. Anticholesterol-induced myositis can cause a reversible ptosis, and thus, a thorough evaluation of adult patients presenting with involutional ptosis includes inquiry into the use of anticholesterol drugs and associated muscle weakness.

Accepted for publication August 4, 2019.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Constance L. Fry, M.D., Department of Ophthalmology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MSC 6230, San Antonio, TX 78229. E-mail: fryc@uthscsa.edu

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.