Levator Muscle Function Research Articles

Intra-orbital developmental arrest of the levator muscle in congenital ptosis with poor levator muscle excursion, A case report

Levator muscle dystrophy is the most approved etiology of simple congenital ptosis. Levator muscle excursion is the commonly used clinical test that determines the type of surgery. Poor levator muscle function has stigmatized the integrity of the levator muscle contractility for long and rationalized the decision of frontalis muscle-based surgical techniques. This is a case of bilateral moderate-to-severe congenital ptosis in an 11-month-old girl with poor levator excursion and high creases. Trans-crease sling surgery was decided. Dissection revealed an evident iris hue denoting the complete absence of levator aponeurosis being replaced by a septal layer covering the Muller-conjunctival complex. The edge of the aponeurosis appeared at the level of the orbital roof. The suturing of the muscle to the anterior surface of the tarsus achieved a good lid position and contour. This report points to the importance of levator muscle exploration even in the presence of poor muscle function to detect other levator muscle pathologies that may change the outcome.

Influence of the Phenylephrine Test in Outcomes of External Levator Advancement for Involutional Ptosis.

This study aims to evaluate the influence of preoperative phenylephrine testing on the surgical outcome of patients undergoing surgery for involutional ptosis by external levator advancement. This was an observational, monocentric, retrospective study. Fifty-one eyelids from 32 patients, who had surgery between January 2018 and May 2023, were included for analysis. Preoperative clinical examination data were collected. Evaluation was performed at 1 month postoperatively. Surgical success was defined by a postoperative margin reflex distance between 3 and 5 mm inclusive. Symmetry success was defined by a difference in margin reflex distance between the 2 upper eyelids of no more than 1 mm. The surgical success rate was 86%. A positive preoperative phenylephrine test was significantly associated with a better surgical success rate (p = 0.01), including on symmetry (p = 0.01). The secondary outcomes, namely preoperative margin reflex distance, function of the upper eyelid levator muscle, and unilaterality of surgery, were not statistically associated with surgical outcome. The phenylephrine test is a predictive factor of surgical success in patients undergoing external levator advancement. Our study suggests that patients with a negative phenylephrine test should be overcorrected intraoperatively.

One Incremental Stride for Doxycycline, One Substantial Advancement for Thyroid Eye Disease.

The aim of this study is to assess the effectiveness of a 12-week doxycycline treatment for thyroid eye disease (TED), an autoimmune condition associated with thyroid dysfunction. In this randomized controlled clinical trial, 82 patients were randomly assigned at a 1:1 ratio to receive doxycycline (50 mg) or to undergo no treatment. Various metrics, including margin reflex distance (MRD1 and MRD2), eyelid aperture, levator muscle function, lagophthalmos, proptosis, ocular motility, diplopia, and Graves' ophthalmopathy-specific quality-of-life (GO-QOL) scale scoring were assessed. Exclusion criteria were uncontrolled systemic diseases, tetracycline allergies, pregnancy, lactation, or age below 18. The mean age was 51.6 years (SD), 87.8% of participants were female, and all were Caucasians. By week 12, the doxycycline group exhibited a significant improvement rate based on MRD2 (from 4 to 15 participants with physiological findings), clinical activity score (from 7 to 35 participants with non-active disease), and GO-QOL (from 51.22% to 70.73% of participants with a good life quality). Doxycycline showcased anti-inflammatory and immunomodulatory effects in treating TED, suggesting its potential efficacy for TED and other orbit inflammatory conditions. However, these results warrant further validation through future research involving extended follow-up periods and larger cohorts.

Comparison Of Frontalis Sling With Or Without Tarsal Fixation Sutures For Severe Ptosis With Poor Levator Function

Objective: To compare the outcomes of frontalis sling with tarsal fixation or without tarsal fixation suture in patients of severe ptosis with poor levator function. Methods: This QUASI-experimental study was conducted at the College of Ophthalmology & Allied Vision Sciences/King Edward Medical Study after obtaining ethical approval vide no 2162/22. Ten Patients above 10 years of age and having levator muscle function of less than 4mm were selected by probability consecutive sampling. Those patients who were diagnosed with Blepharophimosis, Marcus Gun phenomenon, CN III palsy and other lid or facial deformities were excluded. Patients were equally divided into two groups A and B. Group A patients underwent fascia lata sling with tarsal fixation while Group B patients underwent simple fascia lata sling without tarsal fixation. Postoperatively (1 week) surgical success including marginal reflex distance (MRD) and complications including slippage of the sling, exposure keratopathy, recurrence and lid margin deformity were evaluated. Paired t-test and Independent sample t-test were applied to check for statistical significance. Results: Eight out of ten patients had bilateral ptosis with poor levator muscle function while the other two patients had unilateral ptosis. Changes in the marginal reflex distance and palpebral fissure height after surgery were statistically significant. Both marginal reflex distance and palpebral fissure height were statistically better in group A as compared to group B (0.001 & 0.003) respectively. Conclusion: Cosmetic results are better when a fascia lata sling is done with tarsal fixation sutures. Keywords: Ptosis, Fascia lata, Patients

Symmetry of upper eyelid after unilateral blepharoptosis repair with minimally invasive conjoint fascial sheath suspension technique.

To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath (CFS) suspension. A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021. Inclusion criteria included unilateral mild and moderate ptosis, good levator muscle function (>9 mm) and follow-up of at least 6mo. Pre- and post-operative symmetry was graded subjectively for marginal reflex distance 1 (MRD1), tarsal platform show (TPS) and eyebrow fat span (BFS). A t-test was used to evaluate MRD1, TPS and BFS asymmetry by calculating delta values. The Bézier curve tool of the Image J software was used to extract the upper eyelid contours, where the symmetry was measured by the percentage of overlapping curvatures (POC). Totally 105 patients (105 eyelids) were included (mild group, n=84; moderate group, n=21). Postoperatively, all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS. The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively, and it decreased to 0.58±0.67 postoperatively in all cases (P=0.0004). In patients with mild ptosis, the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38 (P=0.0187). The symmetry of the upper eyelid contour increased in all subgroups of patients, with a POC of 59.39%±13.45% preoperatively and POC of 78.29%±13.80% postoperatively. Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1 (all subgroups), POC (all subgroups) and TPS (only mild group), whereas BFS is unaffected.

Management of congenital blepharoptosis in pediatric patients

IntroductionPalpebral ptosis corresponds to the lowered positioning of the upper eyelid margin (MRD1) in primary gaze. The objective of this work is to present the response to surgical treatment of palpebral ptosis operated in the last 3 years. MethodsThis was a retrospective study that included pediatric patients less than 15 years old operated for palpebral ptosis at the Pediatric Plastic Surgery Service from 2021 to 2023. We report 13 cases of operated blepharoptosis in 19 eyelids. The variables were MRD1 level in primary gaze pre and postoperative, levator muscle function, cause, associated syndrome, unilateral or bilateral, age, type of surgery (frontal sling vs. levator resection), and complications. Excellent response was defined when symmetric MRD1 was achieved, good response in 1 MRD asymmetry, and poor response in 2 or more MRD1 asymmetry. Results7 cases were myogenic, 2 mechanical, 1 neuropathic, and 3 blepharophimosis-ptosis-epicanthus inversus syndrome. The ages at surgery for severe ptosis were 3 months, 6 months and 2 years and the average age for moderate ptosis was 7 years (range 6 months to 15 years). Three patients were resolved with levator muscle advancement and resection and three with frontal sling. In the case of mechanical ptosis, plasty of the scar and resection of the mass was performed with resolution of the ptosis. Ten patients had an excellent response and 3 had good response. One lagophthalmos, hematoma, partial relapse and two entropions were presented as complications. ConclusionBlepharoptosis is a condition that must be managed in a multidisciplinary way to achieve symmetry in the gaze and reduce related complications. We have observed a good response with the levator muscle resection and frontal sling techniques. Leve of evidence4

Comparison of clinical outcomes of conjunctivo-mullerectomy for varying degrees of ptosis

To compare the success of conjunctivo-mullerectomy in patients with varying degrees of ptosis and identify factors affecting outcomes and complications. The prospective cohort was studied in patients with ptosis undergoing conjunctivo-mullerectomy with or without tarsectomy were enrolled. Ptosis was classified as mild, moderate, and severe per margin-to-reflex distance 1 (MRD1). Postoperative MRD1, complications, and 3-month success rates were evaluated. The study enrolled 258 ptotic eyes of 159 patients. Most eyes (233; 90.3%) achieved surgical success, 14 (5.4%) were overcorrected, and 11 (4.3%) were undercorrected. The success rates for mild, moderate, and severe ptosis were 96.6%, 91.7%, and 83.5%, respectively. The mild and moderate ptosis groups had a nonsignificant difference in success (− 4.9%; 95% CI − 12.0% to 4.5%; P = 0.36). However, the mild and severe ptosis groups’ rates significantly differed (− 13.1%; 95% CI − 23.6% to − 1.9%; P = 0.03). For all 3 ptosis groups, the success rates of individuals undergoing surgery without tarsectomy did not significantly differ. Patients undergoing conjunctivo-mullerectomy with tarsectomy had an increased risk of unsuccessful surgery (OR 3.103; 95% CI 1.205–7.986; P = 0.019). In conclusions, Conjunctivo-mullerectomy is safe and effective for all ptosis severities. The success rate was significantly lower for severe ptosis than mild or moderate ptosis. Levator muscle function was not associated with unsuccessful outcomes, but tarsectomy was.

Congenital ptosis repair in children: comparison of frontalis muscle suspension surgery and levator muscle surgery.

Comparing the surgical and refractive outcomes of congenital ptosis repair by different surgical techniques. This longitudinal cohort study reviewed medical records of 101 patients who underwent congenital ptosis repair, from 2006 to 2022 in a single center. Analysis was performed for demographic background, co-morbidities, pre-operative and post-operative ocular examinations and refraction, complications, reoperations, and success rates. Following exclusion criteria, we remained with 80 patients (103 eyes) who underwent either frontalis muscle suspension surgery (FMS) (55 eyes) or levator muscle surgery (LM) (48 eyes). Patients in the FMS group were younger (mean age of 3.1 vs. 6.0years, p < 0.001) and had worse pre-operative ocular assessments including prevalence of visual axis involvement, chin-up head position, ptosis severity, and levator muscle function (LF) (p < 0.001). Both groups had a 25% rate of reoperation, however while in the LM group reoperation was required solely due to undercorrection, in the FMS group various indications prompted reoperation. Success rate was higher in the FMS group (87.3% vs. 60.4%, p = 0.002). While pre-operative astigmatism was higher in the LM group (p = 0.019), no significant differences were observed post-operatively. Spherical and spherical equivalent changes over time were significant only in the FMS group (p = 0.010 and p = 0.004, respectively). Within our cohort, a higher success rate of congenital ptosis repair was observed among patients who underwent FMS compared to LM, despite similar reoperation rates. In cases of severe ptosis and moderate LF, LM demonstrated a lower-than-anticipated success rate. Astigmatic changes following ptosis repair were not consistent in either group.

Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis

In patients with severe blepharoptosis, the function of the levator muscle is usually weak. Even if a large amount of levator is resected, under-correction and recurrence often occur postoperatively. Frontalis suspension is the first choice for severe ptosis; however, the external orbital lifting force of the frontalis causes non-physiological eyelid movement. Conjoint fascial sheath (CFS) is a fibrous tissue which can provide dynamic movement of upper eyelids and has been applied for the treatment of mild and moderate blepharoptosis in recent years. This study aims to assess the efficacy and safety of CFS suspension combined with levator muscle advancement for treating severe blepharoptosis. A retrospective study included 44 patients (60 eyelids) with severe ptosis who underwent the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 (MRD1) were measured. Surgical outcomes, symmetry results and complications were evaluated postoperatively. At the 12–18 months follow-up, adequate or normal correction was achieved in 56 eyelids (93.3%), and 37 patients (84.1%) presented good or fair symmetry results. The most common complication was conjunctival prolapse, which was observed in six eyelids (10.0%), followed by lid fold deformity and under-correction. No exposure keratitis was recorded. In conclusion, the modified technique can physically elevate the eyelid with limited tissue injury and is effective for the correction of severe ptosis. Both satisfactory functional and esthetic results were achieved, and severe complications (such as exposure keratitis) were not observed.

Clinical Characteristics of Post-surgical Ptosis Patients at Dr. Mohammad Hoesin General Hospital Palembang

Introduction: Blepharoptosis is drooping of the upper eyelid in a primary position, causing the narrowing of the palpebral fissure. This condition can partially or completely cover the visual axis. Establishing the diagnosis of ptosis requires a comprehensive eye examination, including history taking, physical examination, and examination of the eyelids in ptosis patients. The majority of patients with ptosis require surgery, and clinical characteristics play an important role in classifying the type of ptosis and then formulating a detailed treatment plan strategy so that a better outcome is obtained.&#x0D; Methods: A descriptive retrospective study was conducted from medical records of post-surgical ptosis patients at Dr. Mohammad Hoesin Hospital Palembang from January 2016 to December 2021. The data taken included age, gender, the onset of occurrence, laterality, type of ptosis based on the onset, vertical palpebral fissure (FPV), horizontal palpebral fissure (FPH), margin-reflex distance (MRD), margin limbal distance (MLD), lid lag, bell's phenomenon levator muscle function, type of ptosis surgery and postoperative condition. This study aims to determine the clinical characteristics of patients with ptosis at Dr. Mohammad Hoesin Hospital Palembang.&#x0D; Results: Of the 57 ptosis patients in this study, the majority of patients were male, as many as 32 patients (56.1%) with the age category &gt;40 years, as many as 24 patients (42.1%) with unilateral lateral ptosis as many as 50 patients (87.7%) with the more frequent comparison was the left eye in 29 patients (58%). Acquired ptosis was the most common cause in this study in as many as 46 patients (80.7%), and the most common mechanism of acquired ptosis was neurogenic (33.3%). The majority of patients had no previous surgical history of 41 patients (71.9%), moderate levator function of as many as 42 (73.7%), and frontal suspension surgery technique with synthetic materials as many as 17 (34%) patients. the mean FPV was 5.08±2.627 with a median of 5.00 (0-11), FPH 25.94±1.726 with a median of 26.00 (20-29), MRD 0.246±1.78 with a median of 0.00 (-4 -5), MLD 4.789±2.801 with a median of 5.00 (-4-11) and LA 7.16±4.083 with a median of 7.00 (0-14). Ptosis patients had negative lid lag in 47 patients (82.5%) and positive bell's phenomenon in 49 patients (86%). The postoperative condition of ptosis patients was satisfactory where there was no recurrence and reoperation of ptosis, postoperative complications as many as 1 (1.8%) patients experienced overcorrection, 6 (10.5%) patients experienced lagophthalmos, and 2 (3.5%) patients had an outcome. asymmetric.&#x0D; Conclusion: Clinical characteristics of ptosis patients can determine the diagnosis and treatment that will be given to the patient.

Frontalis Sling Procedure for Blepharoptosis Following Trauma to the Head

Blepharoptosis is a relatively common condition and the treatment remains unpredictable as the choice of one of the many surgical options relies on the cause of the ptosis. We report a case of severe blepharoptosis, the surgical technique, the materials that were used the post-op outcomes. Frontalis suspension is a commonly used surgery that is indicated in patients with blepharoptosis and poor levator muscle function. This surgery connects the eyelid to the brow with a sling material and utilizes the power of the frontalis muscle to elevate the poorly functioning eyelid. In our, discussion we propose possible treatments in severe blepharoptosis such as resection and advancement of the levator aponeurosis, The Whitnall sling procedure, the frontalis muscle flap procedure, use of fascia lata, and Müller's muscle-conjunctival resection surgery. We elaborate on our predilection for use of the Frontalis sling procedure. Even though our patients may suggest that using general anesthesia is better for their comfort we prefer, and recommend the use of local anesthesia with intravenous sedation due to the advantage of the ease in balancing the lids during surgery. Deciding on which technique to use depends on many factors such as the operator experience, their comfort level with various techniques, the degree of ptosis of levator muscle function.

Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision.

Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision. From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively. Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma. The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Levator muscle resection for simple congenital ptosis: its impact on preoperative levator function and dose-response ratio

ObjectifLa présente étude avait pour principal objectif de calculer la relation dose-réponse chez des patients présentant différents degrés de fonction musculaire du releveur à la suite d'une résection de ce muscle dans le traitement d'un ptosis congénital simple. Le paramètre secondaire consistait en une évaluation du taux de réussite et de l'effet de la résection du releveur sur sa fonction après l'intervention. MéthodesDans le cadre de cette étude rétrospective, les dossiers médicaux de patients ont été passés en revue en fonction de l’âge, du sexe, de la latéralité, des mesures pré- et postopératoires (hauteur de la fente palpébrale, distance entre le centre de la pupille et le bord supérieur du tarse [MRD1, pour marginal reflex distance 1] et fonction musculaire du releveur), de l'ampleur de la résection du releveur, de la durée du suivi et des complications postopératoires. RésultatsSur l'ensemble des 154 patients (âge moyen : 17,12 ± 11,14 ans), 54 patients bénéficiaient d'une excellente fonction musculaire du releveur, 41, d'une bonne fonction et 59, d'une fonction acceptable. Après l'intervention, la fonction musculaire moyenne du releveur est passée de 8,81 ± 3,40 mm à 11,29 ± 3,25 mm. L'ampleur de l'amélioration dans les 3 groupes se chiffrait comme suit : 3,18 ± 2,63 dans le groupe fonction excellente, 2,53 ± 2,24 dans le groupe bonne fonction et 1,92 ± 1,80 mm dans le groupe fonction acceptable, respectivement. Le taux de réussite s’élevait à 81,8 %, sans qu'il n'y ait de différence statistiquement significative entre les 3 groupes. Selon la régression logistique multivariée, un âge plus avancé, une anesthésie locale et un ptosis moins important étaient tous des facteurs de prédiction d'une réussite de l'intervention. On a réalisé un tableau de la relation dose-réponse qui permet de calculer le degré de résection du releveur pour obtenir 1 mm de MRD1 et une amélioration de la fonction musculaire du releveur. ConclusionsLe taux de réussite de la résection du releveur en présence d'un ptosis congénital simple est élevé. La fonction musculaire du releveur s'est améliorée de manière significative après l'intervention, et le taux d'amélioration était plus élevé chez les patients qui bénéficiaient déjà d'une meilleure fonction du releveur avant la chirurgie.

Smartphone-Based Artificial Intelligence-Assisted Prediction for Eyelid Measurements: Algorithm Development and Observational Validation Study.

BackgroundMargin reflex distance 1 (MRD1), margin reflex distance 2 (MRD2), and levator muscle function (LF) are crucial metrics for ptosis evaluation and management. However, manual measurements of MRD1, MRD2, and LF are time-consuming, subjective, and prone to human error. Smartphone-based artificial intelligence (AI) image processing is a potential solution to overcome these limitations.ObjectiveWe propose the first smartphone-based AI-assisted image processing algorithm for MRD1, MRD2, and LF measurements.MethodsThis observational study included 822 eyes of 411 volunteers aged over 18 years from August 1, 2020, to April 30, 2021. Six orbital photographs (bilateral primary gaze, up-gaze, and down-gaze) were taken using a smartphone (iPhone 11 Pro Max). The gold-standard measurements and normalized eye photographs were obtained from these orbital photographs and compiled using AI-assisted software to create MRD1, MRD2, and LF models.ResultsThe Pearson correlation coefficients between the gold-standard measurements and the predicted values obtained with the MRD1 and MRD2 models were excellent (r=0.91 and 0.88, respectively) and that obtained with the LF model was good (r=0.73). The intraclass correlation coefficient demonstrated excellent agreement between the gold-standard measurements and the values predicted by the MRD1 and MRD2 models (0.90 and 0.84, respectively), and substantial agreement with the LF model (0.69). The mean absolute errors were 0.35 mm, 0.37 mm, and 1.06 mm for the MRD1, MRD2, and LF models, respectively. The 95% limits of agreement were –0.94 to 0.94 mm for the MRD1 model, –0.92 to 1.03 mm for the MRD2 model, and –0.63 to 2.53 mm for the LF model.ConclusionsWe developed the first smartphone-based AI-assisted image processing algorithm for eyelid measurements. MRD1, MRD2, and LF measures can be taken in a quick, objective, and convenient manner. Furthermore, by using a smartphone, the examiner can check these measurements anywhere and at any time, which facilitates data collection.

Factors that influence the postoperative upper eyelid position following surgery for involutional blepharoptosis

External levator advancement is commonly performed for involutional blepharoptosis repair; however, it is difficult to predict the postoperative upper eyelid position (UEP) accurately in blepharoptosis surgery. The purpose of this study was to determine the factors that influence postoperative UEP following surgery for involutional blepharoptosis. We retrospectively studied 40 Japanese women (80 eyelids) who underwent bilateral external levator advancement surgery. We used digital analysis software to measure the UEP and the eyebrow position from straight-gaze view photographs. Statistical analysis was performed to determine the correlation between postoperative UEP and related factors, including age, levator function, amount of levator advancement, anatomical fixed position, and preoperative and intraoperative UEP. We also compared UEP changes in mild, moderate, and severe ptosis groups. Levator function affected both preoperative and postoperative UEP. The amount of levator advancement and the anatomical fixation position on the aponeurosis did not affect the postoperative UEP. However, both preoperative (r=0.49) and intraoperative (r=0.55) UEPs affected the postoperative UEP. In cases of severe ptosis, there was significant re-drooping after surgery, while in cases with mild ptosis, the intraoperative eyelid position was maintained or slightly elevated. In involutional blepharoptosis, the degree of preoperative and intraoperative UEP contributed to the postoperative eyelid position. These data suggested that the levator muscle function is a major contributing factor in the pathogenesis of involutional blepharoptosis.

Modified Maximal Levator Palpebrae Superioris Shortening in Correcting Congenital Severe Ptosis in Children.

This study aims to evaluate the clinical effect of modified maximal levator palpebrae superioris shortening method for severe congenital ptosis. A retrospective case series was performed including 66 eyes from 62 patients who underwent modified maximal levator palpebrae superioris shortening surgery to treat severe congenital ptosis between February 2015 and November 2018. Preoperative and postoperative margin reflex distance 1 and levator muscle function were recorded. The surgical results were graded as good, satisfied, and poor for functional and cosmetic improvement of the eyelids, and the incidence of complications was also documented. The mean patient age at the time of surgery was 4.6 ± 1.8 years (2-9 years), and the mean follow-up time was 36.3 ± 14.1 (12-55 months). A mean significant improvement in margin reflex distance 1 and levator function after operation was noted (P < 0.01). The eyelid height and symmetry were satisfied in 59 patients, with success rate of 95.2%. For the patients in the levator function (≤2 mm) group, the success rate was 87.5%. Moreover, the levator function (≤2 mm) group had a higher rate of poor results than levator function (2-4 mm) group (12.5% vs 2.2%). Overcorrection (6.5%) and eyelid fold deformity (11.3%) were the most frequent postoperative complications. Modified maximal levator palpebrae superioris shortening was effective and endurable in the treatment of severe congenital ptosis with poor levator function, including in patients whose levator function was less than 2 mm.

Evaluation of Periorbital Tissues in Obstructive Sleep Apnea Syndrome.

Objectives:To evaluate periorbital tissue alterations including eyelid laxity and eyelash ptosis in patients with obstructive sleep apnea syndrome (OSAS).Materials and Methods:Based on polysomnography, 96 eyes of 48 patients with moderate/severe OSAS (Group 1) and 44 eyes of 22 patients with simple snoring (Group 2) were enrolled. Comprehensive eye examination along with eyelid laxity measurements including vertical and anterior distraction, presence of dermatochalasis, interpalpebral distance, and levator function were assessed. The presence and severity of eyelash ptosis were also noted.Results:The mean ages of Group 1 and Group 2 were 49.9±11.4 (range: 26-67) and 50.6±8.9 (range: 27-69) years, respectively (p=0.557). The mean vertical and anterior distraction distances in Group 1 (13.3±4.1 [range, 6-27] mm and 7.4±2.1 [range, 3-13.5] mm, respectively) were significantly higher than in Group 2 (p<0.05). Dermatochalasis and eyelash ptosis were found to be significantly more frequent in Group 1 (52.1% and 81.3%, respectively). The severity of eyelash ptosis was also higher in OSAS (p<0.05). No significant difference in interpalpebral distance or levator muscle function was detected.Conclusion:In patients with severe OSAS, eyelid laxity was more prominent and eyelash ptosis was more frequent and severe.

Influence of Various Factors on Results on Phenylephrine Test

Phenylephrine test is one of the main factors determining the possibility of performing superior tarsal muscle resection. However, the influence of various factors on its result remains unexplored.Aim. To evaluate the effect of patient age, degree of ptosis, and levator muscle function on the result of the phenylephrine test.Patients and methods. 45 patients were examined (64 eyelids). The following examinations were performed for all patients: assessment of the degree of ptosis, levator muscle function and the phenylephrine test.Results. Age and the degree of ptosis do not affect the results of the phenylephrine test. Reduced levator muscle function leads to a decrease of the phenylephrine test results.Conclusion. The phenylephrine test remains an important criteria for patient selection for the planning superior tarsal muscle resection. Levator muscle function does affect the phenylephrine test result.

Unilateral congenital eyelid eversion: An unusual presentation

Congenital eyelid eversion is a rare condition of unknown aetiology. It has a higher prevalence in males and African populations, particularly in west African countries. Eyelid eversion is thought to be caused by birth trauma and/or intrauterine factors in the presence of certain predisposing factors. These factors include a vertically short anterior lid lamellae or vertical elongation of the posterior lamellar, generalised tissue hyperelasticity, congenital elevator disinsertion, absence of levator muscle function and/or some other intrinsic lid abnormality. Once everted, irritation of the eye causes orbicularis muscle spasm. This acts as a sphincter resulting in conjunctival strangulation with venous congestion and stasis. Increasing venous congestion causes conjunctival oedema that worsens the eyelid eversion. Here, we present one of the first known cases of congenital eyelid eversion that was successfully treated with conservative measures in a South African setting.

The prevalence of anophthalmic socket syndrome and its relation to patient quality of life.

Following removal of the eye, soft tissue changes of the eyelids and orbit may develop into an anophthalmic socket (AS) syndrome, which is often attributed to orbital volume deficiency. While adequate primary orbital volume replacement is nowadays standard of care, patients may still present with facial asymmetry. The aim of this study is to provide insights into these changes and their impact on patient quality of life (QoL). Cross-sectional study of 59 patients with longstanding ocular prosthetic wear after enucleation or evisceration surgery. The alignment, function, and laxity of the eyelids of the anophthalmic side were compared to those of the fellow side. The QoL was assessed with a 4-item questionnaire specific for the prosthetic condition. The different aspects of AS syndrome were analysed in relation to disease-specific and prosthetic data and to the patient QoL scores. Clinical AS syndrome was prevalent in 53% of patients with acquired anophthalmia. The anophthalmic side was statistically significantly different from the fellow side for the known AS syndrome features such as superior sulcus depression, margin reflex distance 1, and enophthalmia, but also for new features such aslevator muscle function and lagophthalmia (P < 0.05). The difference was correlated with duration of prosthetic wear, prior orbital radiotherapy, and size of the prosthesis (P < 0.05). QoL scores were not correlated to the separate features of AS syndrome, except for a positive correlation between wearing comfort of the prosthesis and upper eyelid ptosis (P < 0.05). Patients with an ocular prosthesis show a relatively high prevalence of one or more distinct clinical features of AS syndrome, which do not negatively affect patient QoL. These findings underscore the importance to tailor prosthetic and surgical treatment to the patient's perceived QoL rather than to the objective clinical findings.