Widening of Palpebral Fissure Due to Lateral Rectus Muscle Recession

Sung Bok Lee; Dong Won Heo; Han Min Lee; Yeon Hee Lee

doi:10.3341/jkos.2013.54.8.1269

Journal List > J Korean Ophthalmol Soc > v.54(8) > 1009458

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Heo, Lee, and Lee: Widening of Palpebral Fissure Due to Lateral Rectus Muscle Recession

Original Article

J Korean Ophthalmol Soc 2013;54(8):1269-1274.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.8.1269

Widening of Palpebral Fissure Due to Lateral Rectus Muscle Recession

Sung Bok Lee, MD, Dong Won Heo, MD, Han Min Lee, MD, Yeon Hee Lee, MD

Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea

Address reprint requests to Yeon Hee Lee, MD Department of Ophthalmology, Chungnam National University Hospital #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea Tel: 82-42-280-7602, Fax: 82-42-255-3745, E-mail: opticalyh@hanmail.net

This study was presented as a poster at the 106th Annual Meeting of the Korean Ophthalmology Society 2011.

Received 30 November 201222 February 2013 Accepted 20 June 2013

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 incidence and course of widening of palpebral fissure after unilateral lateral rectus muscle recession.

Methods

The palpebral fissure width (PFW) was measured in 20 patients with intermittent exotropia before unilateral rec-tus muscle recession and 1 week, 1 month and 6 months after the surgery.

Results

The amount of recession was from 7.5 to 9.0 (mean 8.37 ± 0.51) mm. More than 0.6 mm of change in PFW after surgery was defined as the significant change. The significant change was observed in 10 patients (50%) after 1 week, 7 patients (35%) after 1 month and 7 patients (35%) after 6 months after the surgery. The amount of recession was sig-nificantly greater in the group with significant change (8.60 ± 0.39 mm) than the group without significant change (8.15 ± 0.53 mm) (p < 0.05).

Conclusions

Thirty five percent of the patients showed palpebral fissure widening lasts at least 6 months after unilateral lateral rectus muscle recession. We think it is necessary to notice patients about the possible change in palpebral fissure width before strabismus surgery. And we believe that more cosmetically satisfactory outcome would be resulted if surgeons consider eyelid condition when they are planning strabismus surgery.

Keywords: Lid change, Palpebral Fissure, Rectus recession, Strabismus surgery

References

1. Lueder GT, Scott WE, Kutschke PJ, Keech RV. Long-term results of adjustable suture surgery for strabismus secondary to thyroid ophthalmopathy. Ophthalmology. 1992; 99:993–7.

2. Pacheco EM, Guyton DL, Repka MX. Changes in eyelid position accompanying vertical rectus muscle surgery and prevention of lower lid retraction with adjustable surgery. J Pediatr Ophthalmol Strabismus. 1992; 29:265–72.

3. Lam BL, Lam S, Walls RC. Prevalence of palpebral fissure asym-metry in white persons. Am J Ophthalmol. 1995; 120:518–22.

4. Kwak CY, Yu YS. Analysis of lid contours in children. J Korean Ophthalmol Soc. 1991; 32:520–6.

5. McCracken MS, del Prado JD, Granet DB. . Combined eyelid and strabismus surgery: examining conventional surgical wisdom. J Pediatr Ophthalmol Strabismus. 2008; 45:220–4.

6. Lagrèze WA, Gerling J, Staubach F. Changes of the lid fissure after surgery on horizontal extraocular muscle. Am J Ophthalmol. 2005; 140:1145–6.

7. Santos de Souza Lima LC, Velarde LG, Vianna RN. . The ef-fect of horizontal strabismus surgery on the vertical palpebral fis-sure width. J AAPOS. 2011; 15:473–5.

8. Chen SI, Knox PC, Hiscott P, Marsh IB. Detection of the slipped extraocular muscle after strabismus surgery. Ophthalmology. 2005; 112:686–93.

9. Lenart TD, Reichman OS, McMahon SJ, Lambert SR. Retrieval of lost medial rectus muscles with a combined ophthalmologic and otolaryngologic surgical approach. Am J Ophthalmol. 2000; 130:645–52.

10. Ahuero AE, Hatton MP. Eyelid malposition after cataract and re-fractive surgery. Int Ophthalmol Clin. 2010; 50:25–36.

Figure 1.

Measurement of the Palpebral fissure width. We measured the distance between upper and lower eyelid margin by placing the image of reference ruler on point of corneal re-flex after cut off it on the same photograph.

Figure 2.

Incidence rate of the significant change of palpebral fissure width at each follow up point.

Table 1.

Demographics of the subjects

Subjects	n = 20
Age (years)	7.75 ± 2.91
Gender: Female (%)	14 (70.0%)
Laterality : Left eye (%)	16 (80.0%)
Preoperative deviation (prism diopter)	19.10 ± 3.72
Amount of LR recession (mm)	8.37 ± 0.51 (7.5-9.0)

Values are presented as mean ± SD.

LR = lateral rectus muscle.

Table 2.

The differences between both eyes and amount of change in palpebral fissure width (PFW) and mean width of operated eye (mm)

Subjects	Baseline	1 week	1 month	6 months
1	0.4	1.6 (1.2)^*	1.6 (1.2)^*	1.6 (1.2)^*
2	0	0.6 (0.6)^*	0.6 (0.6)^*	0.6 (0.6)^*
3	0	1 (1)^*	0.8 (0.8)^*	0.8 (0.8)^*
4	0	0.6 (0.6)^*	0 (0)	0 (0)
5	0	0.6 (0.6)^*	0 (0)	0 (0)
6	0	1 (1)^*	1 (1)^*	0.6 (0.6)^*
7	0	0.6 (0.6)^*	0.8 (0.8)^*	0.8 (0.8)^*
8	0	0.6 (0.6)^*	1 (1)^*	1 (1)^*
9	0	0.6 (0.6)^*	1 (1)^*	1 (1)^*
10	0	0 (0)	0 (0)	0 (0)
11	1	1 (0)	1 (0)	1 (0)
12	0.4	0.6 (0.2)	0.6 (0.2)	0.4 (0)
13	0	0 (0)	0 (0)	0 (0)
14	0	0 (0)	0 (0)	0 (0)
15	0	0 (0)	0 (0)	0 (0)
16	0.4	0.4 (0)	0.4 (0)	0.4 (0)
17	0.4	0.4 (0)	0.4 (0)	0.4 (0)
18	0.2	0.8 (0.6)^*	0.4 (0.2)	0.4 (0.2)
19	0.4	0.4 (0)	0.4 (0)	0.4 (0)
20	0.2	0.2 (0)	0.2 (0)	0.2 (0)
Mean PFW	7.76 ± 1.04	8.05 ± 1.01	8.13 ± 0.99	8.04 ± 0.80

Values are presented as mean ± SD; Numbers in parenthesis are amounts of the change in PFW after surgery.

^* The significant changes.

Table 3.

Comparison of parameters between the group with the significant change and the group without significant change

	Significant change	No significant change	p-value^*
Age (years)	7.0 ± 1.56	8.5 ± 3.77	0.529
Preoperative deviation (prism diopter)	21.2 ± 3.61	17.0 ± 2.53	0.015
Amount of LR recession (mm)	8.60 ± 0.39	8.15 ± 0.53	0.048

Values are presented as mean ± SD.

LR = lateral rectus muscle.

^* Mann-Whiteny U test.

TOOLS

Similar articles