Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010442

Lee, Jeon, and Choi: Clinical Feature of Unilateral Ptosis with Positive Result in Phenylephrine Test

Abstract

Purpose

To investigate the clinical features and therapeutic effects of unilateral ptosis in patients who respond to the phenylephrine (PE) test.

Methods

Patients who presented with unilateral ptosis from January 2010 to December 2014 and underwent a PE test were included in the analysis. A 2.5% ophthalmic solution of phenylephrine hydrochloride was instilled at the superior conjunctival fornix in the ptotic eye. After 10 minutes of instillation, the patients' eyelid heights were evaluated. Underlying systemic diseases were examined based on previous medical history, a blood test, neurologic examination, and radiologic imaging findings.

Results

Twenty-six of 44 patients who underwent a PE test showed positive results. Fourteen (53.8%) patients with positive PE test had systemic disease, and 2 (11.2%) patients had systemic disease with negative PE test. In the positive PE test group, the associated systemic disease frequency was remarkably high (p = 0.004). Myasthenia gravis (MG) was found more frequently in the positive PE test group than in the negative PE test group (p = 0.031). After 6 months, the interpalpebral fissure height increased by 2.20 mm in the positive PE test group and 2.38 mm in the negative PE test group. Patients receiving medication treatment experienced an increase in interpalpebral fissure height of 2.00 mm in the positive PE test group and 2.50 mm in the negative PE test group. In patients undergoing observation alone, the interpalpebral fissure height increased by 1.50 mm in the positive PE test group and 0.80 mm in the negative PE test group. There was no significant difference in treatment methods (respectively, p = 0.147, p = 0.228 and p = 0.112).

Conclusions

The PE test can be considered to help with differential diagnosis when examining patients with mild to moderate ptosis. If the PE test is positive, underlying comorbidity including MG should be considered.

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Figure 1.
Distribution of associated systemic diseases in patients with unilateral ptosis according to phenylephrine test results. (A) Positive, (B) Negative. The systemic disease was associated more frequently in patients with positive results.
jkos-57-1678f1.tif
Figure 2.
Distribution of patients according to the management of unilateral ptosis with positive or negative phenylephrine test result. 12 of 26 (46.1%) patients with positive results and 12 of 18 (66.7%) patients with negative results underwent operation. The remaining patients were treated with medication or observed. MMCR = Müller's muscle conjunctival resection.
jkos-57-1678f2.tif
Table 1.
Characteristics of patients
  Phenylephrine test
p-value
Positive Negative
Total number of patients (eyes) 26 (26) 18 (18)  
Sex (male/female) 7/19 8/10 0.233
Mean age at diagnosis (years) 51.6 ± 12.6 49.2 ± 18.2 0.867
Mean BCVA at diagnosis (log MAR) 0.08 ± 0.25 0.12 ± 0.25 0.212
MRD1 (mm) 0.48 ± 0.77 0.33 ± 1.00 0.139
IPF (mm) 5.52 ± 1.09 4.78 ± 1.80 0.107
LF (mm) 7.35 ± 1.49 6.86 ± 2.61 0.146

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; MRD1 = marginal reflex distance 1; IPF = interpalpebral fissure; LF = levator function.

Table 2.
Change of Interpalpebral fissure heights (mm) before and after treatment
Treatment method Before treatment (mm)
6 months after treatment (mm)
Difference (mm)
PE test PE test PE test
Positive Negative Positive Negative Positive Negative
Operation 5.54 ± 1.16 4.56 ± 1.53 7.75 ± 1.21 7.00 ± 0.94 2.20 ± 0.78 2.38 ± 1.43
 MMCR 5.50 ± 1.29 7.85 ± 0.99 2.36 ± 0.63
 Levator resection 5.60 ± 1.08 4.56 ± 1.53 7.60 ± 1.59 7.00 ± 0.94 2.00 ± 1.00 2.38 ± 1.43
Medication 5.00 ± 0.00 3.00 ± 0.00 7.00 ± 1.77 5.50 ± 0.00 2.00 ± 1.78 2.50 ± 0.00
Observation 5.70 ± 1.25 6.00 ± 2.32 7.20 ± 1.34 6.80 ± 2.13 1.50 ± 0.70 0.80 ± 1.62
p-value* 0.521 0.462 0.379 0.154 0.446 0.168
p-value 0.539 0.195 0.346 0.646 0.049 0.039
p-value 0.424 0.425 0.322 0.172 0.044 0.042

Values are presented as mean ± SD unless otherwise indicated. PE = phenylephrine; MMCR = Müller's muscle conjunctival resection.

* Mann-Whitney U-test (Operation vs. Medication)

Mann-Whitney U-test (Operation vs. Observation)

Mann-Whitney U-test (Medication vs. Observation).

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