Ptosis Of Upper Eyelid Research Articles

Loss of vertical palpebral fissure height on downgaze in acquired blepharoptosis.

To determine criteria to diagnose and document functional visual impairment from upper eyelid ptosis in the downgaze position of reading. Prospective clinical study. From September 1991 to June 1992, 47 consecutive patients with adult-onset acquired ptosis were enrolled in the study. Downgaze eyelid and relative brow position were evaluated in 88 eyelids of these patients. Surgical repair of blepharoptosis by the Müller muscle conjunctival resection ptosis procedure, levator aponeurosis advancement and/or resection, or levator muscle resection. Postoperative change in the eyelid and brow position in downgaze. Of all ptotic eyelids, 43% had zero vertical palpebral fissure height in downgaze when the brows were relaxed and therefore were functionally blind in the downgaze position. After ptosis repair, there was a significant widening of the vertical palpebral fissure height in downgaze (P < .001), a significant decrease in frontalis muscle use (P < .001), and return of the patients' ability to sustain downgaze function. Measurement of palpebral fissure height in downgaze and frontalis muscle use in patients with acquired ptosis identifies patients with a functional visual deficit in the downgaze reading position. These measurements can be easily performed in the office and may be added to criteria for documenting functional impairment from blepharoptosis.

Radiological Case of the Month

A 5½-YEAR-OLD boy was referred for evaluation of right orbital swelling. His symptoms started 2 months before his referral, with right orbital swelling and difficulty in using his right eye. He was previously treated by his pediatrician with an oral antibiotic and with antimicrobial eyedrops for suspected periorbital cellulitis, but no response was noted. He had swelling and tenderness of the right supraorbital rim without erythema and a 5-mm right upper eyelid ptosis due to edema. The right globe was depressed (globe ptosis) by 3 mm but was not tender and had full range of movement without pain. The right conjunctiva, fundus, and pupillary reflexes were normal, as were the results of the remainder of his physical examination. The roentgenogram (<b>Figure 1</b>, left) and computed tomogram (Figure 1, right) of the orbits is shown. The patient had a normal roentgenographic skeletal survey and normal serum electrolyte levels. Percutaneous biopsy

Blepharoptosis Induced by Prolonged Hard Contact Lens Wear

The authors attempt to establish a relation between hard contact lens wear and upper eyelid ptosis. This study consists of two parts. In the first part, the authors compare the unilateral or bilateral ptosis that developed during hard contact lens wear in 17 patients with the involutional ptosis that developed in another group of 73 patients. In the second part, the authors compare both upper and lower eyelid position in 46 patients who had been wearing hard contact lenses for at least 10 years with the position of 50 matched controls who had never worn contact lenses. The ptosis that had developed in the 17 patients who wore hard contact lenses was clinically similar to that caused by involutional levator disinsertion. The second part of the study shows that the prolonged wearers of hard contact lenses had upper eyelids that were lower by approximately 0.5 mm when compared with control subjects. This difference is statistically significant. According to standard criteria, there were at least 10 ptotic eyelids in the contact lens group versus 1 in the control group. The study findings suggest that prolonged hard contact lens wear may induce a lower position of the upper eyelid and eventually lead to ptosis through levator disinsertion.

Displaced Orbital Roof Fractures

Of 457 patients with facial fractures admitted by the plastic surgery service from 1986 to 1988 at Wayne State University, there were seven displaced orbital roof fractures in five patients. All presented with supraorbital rim fractures, inferior dystopia, limitation of supraduction, upper eyelid ptosis, and diplopia. Proptosis was present in four orbits in three patients. One of these patients had an orbital floor fracture. However, enophthalmos was present in three orbits in two patients with associated zygoma and floor fractures. Two patients had intracranial neurologic injuries, but no ocular injuries were seen. Patients underwent frontal craniotomy and removal of the supraorbital rim for exposure. The orbital roof was reconstructed with outer-table cranial bone grafts. Associated fractures were repaired. Mean follow-up was 21.4 months. In all patients, the inferior dystopia, proptosis or enophthalmos, limitation of supraduction, and diplopia were corrected. In one patient, residual mild eyelid ptosis was seen. No residual neurologic or ocular injury was seen.

Craniocarpotarsal Dysplasia

Currently, 50 cases of craniocarpotarsal dysplasia, or whistling face syndrome (WFS), have been reported, with more than 60 anatomical anomalies involving the head, hands, and feet, in addition to the face. In spite of the fact that there is much information concerning the surgical correction of many of these deformities, such as the surgical program for the hands outlined by Call and Strickland in 1981, there is little information concerning the surgical correction of facial deformities. In view of this, we present here a case report of a patient with WFS and our surgical approach to the facial deformities involved. Since January 24, 1983, when this 7-year-old girl first came into our care, she has successfully undergone a total forehead reshaping, correction of congenital upper eyelid ptosis, and a bilateral commissuroplasty. Follow-up for more than three years has shown stable surgical results.

A simple approach to identification of the levator aponeurosis in the correction of eyelid ptosis.

A new method of approach for the correction of upper eyelid ptosis is described. This involves both conjunctival and skin incisions. It allows for greater ease of identification of the levator aponeurosis and appears to facilitate in the identification of Müller's muscle. Although advised for all patients requiring ptosis correction, it is particularly recommended in those patients in whom the eyelids are involved with extensive posttraumatic scarring.

Müller's Muscle in the Treatment of Upper Eyelid Ptosis: A Ten-Year Study

Müller's muscle is a sympathetically innervated muscle that can be resected to treat upper eyelid ptosis. Candidates for the ptosis procedure are those whose upper lids elevate to a normal level following instillation of phenylephrine hydrochloride drops into their upper ocular fornix. A specially designed clamp is applied to 6.5 to 9.5 mm of conjunctiva and Müller's muscle above the superior tarsal border. A suture is run distal to the clamp, connecting conjunctiva and Müller's muscle to the superior tarsal border; then, the tissues held in the clamp are resected. In a ten-year study of this procedure, 90% of the lids with acquired ptosis and 100% of those with congenital ptosis were within 1.5 mm of the level of the opposite lid postoperatively. Only two of 232 treated lids required additional surgery.

Müllers muscle-conjunctival resection ptosis procedure.

The Müllers muscle-conjunctival resection procedure is a relatively simple means of relieving upper eyelid ptosis. Candidates for the operation are chosen by placing several drops of 10% phenylephrine hydrochloride into the upper ocular fornix. If the upper lid elevates close to a normal level after five minutes, the patient is selected for the operation. A specially designed clamp is applied to 6.5 to 9.5 mm of conjunctiva and Müllers muscle above the superior tarsal border. A suture is run distal to the clamp, connecting conjunctiva and Müllers muscle to the superior tarsal border, and then the tissues held in the clamp are resected. The Müllers muscle-conjunctival resection has advantages over the Fasanella procedure, because tarsus is preserved, and over the levator aponeurosis advancement and tuck procedures, because the results are much more predictable.

Correction of lower eyelid ptosis in the anophthalmic orbit: a long-term follow-up.

We describe a 10-year review of 53 patients having had correction of lower eyelid ptosis using fascia lata sling suspension by the operation first described in 1973. The overall conclusion is that this continues to be a reliable procedure with a low complication rate. Four major changes relating to operative technique that create a better result are as follows: (1) the surgical correction must begin with a prosthesis that is ideal for the socket; (2) the fascial strip is narrower at 2 mm; (3) the lateral orbital rim burr hole is placed higher; and (4) the passage of the fascial strip is facilitated by the use of Wright's needle. The optimal sequence of operative procedures in the anophthalmic orbit syndrome is (1) correction of enophthalmos and superior sulcus depression, (2) correction of lower eyelid ptosis, and (3) correction of upper eyelid ptosis.