To determine whether lower lid tightening surgery with the lateral tarsal strip technique can lead to a significant increase in intraocular pressure. This could have implications in the management of lower lid laxity in patients with glaucoma.

Prospective observational study of patients undergoing unilateral lateral tarsal strip for lower lid laxity. Intraocular pressure was measured using Goldmann applanation tonometry in the operative and fellow eye immediately pre-op and post-op, and at 2 weeks and 3 months post-operatively. Results were analysed for statistically significant change in intraocular pressure following surgery.

37 patients underwent lateral tarsal strip (mean age 76). Mean pre-operative intraocular pressure in the operative eye was 13.59 mmHg, and 13.89 mmHg in the fellow eye. Mean immediate post-operative intraocular pressure was 15.41 mmHg in the operative eye, and 14.53 mmHg in the fellow eye. There was a statistically significant increase between immediate pre and post-operative intraocular pressure in the operative eye (P = 0.02), but not in the fellow eye. There was also a statistically significant difference found at 3 months post-operatively.

Lower lid tightening with lateral tarsal strip was associated with a statistically significant increase in intraocular pressure immediately post-operatively. In some patients, intraocular pressure remained elevated at 3 months after surgery. Lower lid laxity can occur with increasing age, and older patients frequently present with ocular comorbidities, including glaucoma. The results suggest that lower lid tightening surgery in patients with glaucoma, or glaucoma suspects, requires careful consideration.