Effect of upgaze on lower eyelid position in Korean patients with congenital ptosis

Teo, Livia; Lee, Sang Yeul; Kim, Chang Yeom

doi:10.1016/j.bjps.2016.10.020

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…17 Additionally, they found that the severity of preoperative ptosis was significantly associated with a higher degree of scleral show (MRD-2) in this group, which is consistent with our study findings. 15,17 Surgical intervention is one of the approaches used to correct the position of the lower eyelid, which can be accompanied by complications such as scarring, lagophthalmos, undercorrection, and overcorrection. 19,22 Noninterference with the lower eyelid and focusing on F I G U R E 1 Comparing preoperative versus postoperative MRD-1 and MRD-2.…”

Section: Discussionmentioning

confidence: 99%

“…The proposed mechanism for this phenomenon involves compensatory contractions of the superior rectus/levator complex to improve the superior visual field, which in turn affects the lower eyelid retractor. [12][13][14][15] There is a belief that weakening the levator muscle may result in an additional contraction of the levator muscle, accompanied by traction of the superior rectus muscle, causing an upward rotation of the globe. This, in turn, leads to an additional contraction of the inferior rectus muscle to maintain the horizontal visual axis, which also pulls on the inferior suspensory ligament of Lockwood.…”

Section: Introductionmentioning

confidence: 99%

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Lower eyelid position after ptosis repair in patients with blepharoptosis

Eshraghi,

Karami,

Zandi

et al. 2023

J of Cosmetic Dermatology

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PurposeTo determine the changes in the lower eyelid position, following ptosis surgery of the upper eyelid of the same eye in blepharoptosis patients.MethodsThis prospective interventional before and after study included patients aged more than 5 years with blepharoptosis. Margin reflex distance one (MRD‐1), MRD two (MRD‐2), and levator function were measured before and the 6 months after the surgery.ResultsSixty patients with blepharoptosis (33 congenital and 27 acquired) were recruited. The mean age was 21.61 ± 10.82 and 59.8 ± 13.73 years in congenital and acquired groups, respectively. The mean MRD‐1 improved from 1.95 ± 0.99 before treatment to 4.47 ± 0.47 after treatment (p < 0.001). The mean MRD‐2 improved from 5.57 ± 0.63 before treatment to 4.95 ± 0.51 after treatment (p < 0.001). There was no statistically significant difference in MRD‐1 and MRD‐2 changes between the two groups (p > 0.05) There was no statistically significant correlation between MRD‐2 changes and LF (r = −0.03. p = 0.83).ConclusionPresent study showed a significant improvement in the condition of the lower eyelid improved after upper eyelid ptosis surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lower eyelid position after ptosis repair in patients with blepharoptosis

Eshraghi,

Karami,

Zandi

et al. 2023

J of Cosmetic Dermatology

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“…E yelid ptosis, which is an abnormal function of the levator palpebra superioris muscle or Müller's tarsal muscle, is one of the common eyelid disorders seen in oculoplastic surgery. The etiology of ptosis can be congenital, myogenic, neurogenic, and aponeurotic [1][2][3][4] . Ophthalmic plastic surgeons evaluate levator function (LF) and response to topical phenylephrine for the preoperative evaluation and determination of the appropriate surgical method for ptosis repair, but there is an underestimated situation; upper eyelid ptosis can change the lower eyelid position in both congenital and aponeurotic subgroups of ptosis to maintain the horizontal visual axis without inclination of the head in the primary gaze position [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

“…The etiology of ptosis can be congenital, myogenic, neurogenic, and aponeurotic [1][2][3][4] . Ophthalmic plastic surgeons evaluate levator function (LF) and response to topical phenylephrine for the preoperative evaluation and determination of the appropriate surgical method for ptosis repair, but there is an underestimated situation; upper eyelid ptosis can change the lower eyelid position in both congenital and aponeurotic subgroups of ptosis to maintain the horizontal visual axis without inclination of the head in the primary gaze position [1][2][3][4] . The possible mechanism of this harmony is a compensatory contraction of the superior rectus/levator complex and simultaneous lower eyelid retractor, thereby displacing the globe upward in the orbit and retracting the lower eyelid with a dynamic lower scleral show [1][2] .…”

Section: Introductionmentioning

confidence: 99%

“…The possible mechanism of this harmony is a compensatory contraction of the superior rectus/levator complex and simultaneous lower eyelid retractor, thereby displacing the globe upward in the orbit and retracting the lower eyelid with a dynamic lower scleral show [1][2] . Few previous studies have highlighted this issue and have shown that lower scleral show improves after ptosis surgery [1][2][3][4] . The need for a detailed evaluation of the lower eyelid for more precise and successful ptosis surgery prompted us to design this study.…”

Section: Introductionmentioning

confidence: 99%

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Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

Totuk¹,

Kanra²,

Aykan³

2022

Int J Ophthalmol

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AIM: To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis, to determine the appropriate timing of the phenylephrine test, and to assess the responses of the upper and lower eyelids. METHODS: This was a retrospective analysis of 140 eyes of 87 patients (mean age 52.29±16.45y; 22 males, 65 females) with upper eyelid ptosis. Totally 88.6% had aponeurotic and 11.4% had congenital ptosis. For the evaluation of the responses of the upper and lower eyelids to topical 2.5% phenylephrine, the scleral show height, the marginal reflex distance (MRD) between the inferior margin of the upper eyelid and pupillary light reflex (MRD1), and between the central portion of the lower eyelid and pupillary light reflex (MRD2) were measured at the 2nd, 5th, and 15th minutes. The changes of MRD1 and MRD2 with time (ΔMRD1 and ΔMRD2) were evaluated. RESULTS: The mean MRD1, MRD2, and scleral show heights increased within 5min after testing, remaining largely stable between the 5th-15th minutes. The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis (P<0.05). Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis. The mild ptosis group had lower scleral show measurements and higher ΔMRD2 values. The ΔMRD1 and ΔMRD2 values were poorly correlated in all measurement times. CONCLUSION: Performing the phenylephrine test 5min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids. The upper and lower eyelid responses in phenylephrine testing are poorly correlated. However, the ΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor. Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.

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