Changes of Contralateral Eyelid Position after Unilateral Blepharoptosis Repair

Dong Min Shin; Woo Jin Jeung; Hee Bae Ahn

doi:10.3341/jkos.2008.49.1.1

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Shin, Jeung, and Ahn: Changes of Contralateral Eyelid Position after Unilateral Blepharoptosis Repair

Original Article

J Korean Ophthalmol Soc 2008;49(1):8-13.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.1

Changes of Contralateral Eyelid Position after Unilateral Blepharoptosis Repair

Dong Min Shin, M.D., Woo Jin Jeung, M.D., Hee Bae Ahn, M.D.

Department of Ophthalmology, College of Medicine, Dong-A University, Pusan, Korea

Address reprint requests to Hee Bae Ahn, M.D. Department of Ophthalmology College of Medicine, Dong-A University #3-1 Dongdaeshin-dong, Seo-gu, Pusan 602-715, Korea Tel: 82-051-240-5227, Fax: 82-051-254-1987, E-mail: hbahn@dau.ac.kr

Received 1 August 2006 Accepted 17 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of unilateral blepharoptosis repair on contralateral eyelid position.

Methods

The medical records of 39 patients who had undergone unilateral blepharoptosis repair were reviewed for preoperative and postoperative margin reflex distance (MRD).

Results

Of the 39 patients, 28 (71.8%) had congenital ptosis and 11 (28.2%) revealed acquired ptosis. Twenty-two (56.4%) patients were male and 17 (43.6%) were female. Ages ranged from 3 to 55 years (mean 15.3±20.1 years). After unilateral blepharoptosis repair, the postoperative mean (±SD) change in MRD of nonoperated eye was -0.3±0.7 mm at week one, -0.3±0.6 mm at three months, and -0.2±0.7 mm at six months.

Conclusions

After unilateral blepharoptosis repair, 35.9% of patients had a decrease in contralateral eyelid height at postoperative 3 months and amount of decrease was 0.2±0.7 mm.

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Keywords: Contralateral eyelid position, Unilateral blepharoptosis

References

1. Walsh FB. Clinical neuro-ophthalmology, 2nd ed. Baltimore: Williams & Wilkins,. 1957; 196:778.

2. Lewallen WM. Lid retraction syndrome due to ‘secondary deviation’. Am J Ophthalmol. 1958; 45:565–7.

3. Jain IS. Lid retraction in the non-paretic eye in acquired ophthalmoplegia. Br J Ophthalmol. 1963; 47:757–9.

4. Gupta JS, Jain IS, Kumar K. Lid retraction secondary to contralateral ptosis. Br J Ophthalmol. 1964; 48:626–7.

5. Gay AJ, Salmon ML, Winsor CE. Hering’s law, the levators, and their relationship in disease states. Arch Ophthalmol. 1967; 77:157–60.

6. Lee DS, Chung WS. External levator resection in mild to moderate unilateral ptosis. J Korean Ophthalmol Soc. 2002; 43:1250–5.

7. Kennard DW, Smyth GL. Reflex regulation of the upper eyelids, with observations on the onset of sleep. J Physiol. 1963; 166:168–77.

8. Bowyer JD, Sullivan JS. Management of Marcus Gunn jaw-winking synkinesis. Ophthal Plast Reconstr Surg. 2004; 20:92–8.

9. Robert CK, Bernardini FP, Khouri L, et al. Unilateral frontalis sling for the surgical correction of unilateral poor-function ptosis. Ophthal Plast Reconstr Surg. 2005; 21:412–7.

10. Bodian M. Lid drooping following contralateral ptosis repair. Arch Ophthalmol. 1982; 100:1122–4.

11. Erb MH, Kersten RC, Yip CC, et al. Effect of unilateral blepharoptosis repair in contralateral eyelid position. Ophthal Plast Reconstr Surg. 2004; 20:418–22.

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Figure 1.

Photographs of unilateral frontalis sling operation (A) Before blepharoptosis repair, MRD of the right eye was almost zero. (B) After frontalis sling operation of the right eyelid, MRD of the right eye was 3.0 mm at postoperative 1 week. This patient had no Hering’s law dependence. Contralateral eyelid position was nearly unchanged.

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Figure 2.

Photographs of unilateral levator resection procedure. (A) Before blepharoptosis repair, MRD of the left eye was almost zero. (B) After levator resection procedure of the left eyelid, MRD of the left eye was 1.0 mm at postoperative 3 months. This patient had Hering’s law dependence. Contralateral eyelid position was nearly unchanged.

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Table 1.

Patient demographics

Age	Number of the patients (%)
Age	Male	Female	Total
0∼9	17 (43.6)	11 (28.2)	28 (71.8)
10∼19	0 (0)	0 (0)	0 (0)
20∼29	3 (7.7)	2 (5.1)	5 (12.8)
30∼39	2 (5.1)	2 (5.1)	4 (10.3)
40∼49	0 (0)	0 (0)	0 (0)
50∼	0 (0)	2 (5.1)	2 (5.1)
Total	22 (56.4)	17 (43.6)	39 (100)

Table 2.

The change of MRD^* in non-operated eyelids (No. of eyes (%))

Change of MRD	Postop. 1 week	Postop. 3 months	Postop. 6 months
decreased	25 (64.1)	16 (41.0)	14 (35.9)
same	11 (28.2)	22 (56.4)	25 (64.1)
increased	3 (7.7)	1 (2.6)	0 (0)
Total	39 (100)	39 (100)	39 (100)

^* : Marginal reflex distance.

Table 3.

Mean MRD in operated and non-operated eyelids after unilateral blepharoptosis repair (mm±SD)

Eyelid	Preop. MRD	Postop. 1week MRD	Postop. 3 months MRD	Postop. 6 months MRD
Operated eyelid	0.4±0.9	2.8±0.7^*	2.6±0.7^† ^λ	2.5±0.7^‡ ^Ψ
Non-operated eyelid	3.4±0.6	3.0±0.6^§	3.1±0.7^∏ ^λ	3.2±0.6^#^Ψ

When comparing preoperative and postoperative MRD,

^* p=0.04, between preoperative and postoperative 1week in operated eyelid.

^† p=0.02, between preoperative and postoperative 3 months in operated eyelid.

^‡ p=0.02, between preoperative and postoperative 6 months in operated eyelid.

^§ p=0.03, between preoperative and postoperative 1week in non-operated eyelid.

^∏ p=0.04, between preoperative and postoperative 3 months in non-operated eyelid.

^# p=0.03, between preoperative and postoperative 6 months in non-operated eyelid.

^λ p>0.05, when comparing the each two groups at 3 months.

^Ψ p>0.05, when comparing the each two groups at 6 months.

Table 4.

Mean MRD change after unilateral blepharoptosis repair (mm±SD)

Eyelid	Postoperative MRD change (Postoperative MRD- Preoperative MRD)
Eyelid	Postop. 1 week	Postop. 3 months	Postop. 6 months
Operated eyelid	2.4±0.9^*	2.2±0.8^*	2.1±0.7^*
Non-operated eyelid	-0.3±0.7^*	-0.3±0.6^*	-0.2±0.7^*

When comparing preoperative MRD and postoperative MRD change.

^* p<0.05.

Table 5.

Comparison of mean MRD of non-operated eyelids according to surgical method (mm±SD)

Eyelid (n=39)	Preoperative MRD	Postoperative 6 months MRD	Change
Levator resection (n=17)	3.5±0.6	3.3±0.7	-0.2±0.7
Frontalis sling operation (n=22)	3.3±0.5	3.1±0.6	-0.2±0.5

Differences between groups were not statistically significant.

Table 6.

Comparison of mean MRD change of non-operated eyelids position according to Hering’s law dependence

Hering’s law dependence	Mean MRD change (mm±SD)
Existence (n=15)	-0.2±0.8
Nonexistence (n=24)	-0.2±0.6
Total (n=39)	-0.2±0.7

Differences between groups were not statistically significant.

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