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PubMed2004

The influence of eyelid temperature on the delivery of meibomian oil.

The aim of this study is to establish the effect of heating and cooling of the eyelid on the delivery of oil from the meibomian glands, as indicated by the extent of re-establishment of the reservoir of meibomian oil on the human eyelid margin, resulting from 10 conscious blinks, following pre-cleaning by a hexane swab. A standard handling sequence was followed. Step 1. Both upper and lower eyelids of both eyes of human volunteers were cleaned by a hexane swab and measured by a Meibometer to show satisfactory removal of the pre-existing oil (initial reading less than 60 instrumental units (IU)). The volunteers were then asked to blink 10 times at their normal rate. Then the eyelid was re-measured by the Meibometer. Step 2. The closed eyelids were heated for 5 min by a 250 W infrared lamp from a distance of 50 cm. The eyelid temperature was measured by an infrared thermometer, then Step 1 was repeated. Step 3. The eyelids were cooled for 5 min by an ice-pack (crushed ice in a towel). The eyelid temperature was measured, then Step 1 was repeated. Both eyes of 20 female subjects, aged 68 +/- 3 S.E.M. (range 52-84) years were examined. The mean instrumental reading (IU +/- S.E.M.) after 10 blinks at 33.4 +/- 0.1 degrees C was 154 +/- 12. On increasing the eyelid surface temperature by 4.9 +/- 0.3 degrees C we obtained an increase of 49 +/- 9 IU. On decreasing it by 7.6 +/- 0.4 degrees C we obtained a decrease of 46 +/- 9 IU. We conclude that temperature significantly influences the delivery of the meibomian gland secretion. Our results are in agreement with the 10-blink recovery value of 191 +/- 9.3 IU previously reported. They also agree with the reported benefit of warm compresses to improve delivery from dysfunctional glands. The most likely explanation for our findings is a change in the viscosity of the meibomian oil.

Aged↗
PubMed1991

Keratoconus associated with floppy eyelid syndrome.

Floppy eyelid syndrome is a recently described entity, which characteristically involves overweight individuals. The characteristic findings are an upper lid that may be readily everted, tarsal laxity, and diffuse papillary conjunctival changes. The cause of floppy eyelid syndrome is believed to be a mechanical disorder due to the eversion of the lids while sleeping. The cause of keratoconus remains uncertain. There are strong proponents to a mechanical etiology for this disease. The authors report five cases of floppy eyelid syndrome with concomitant keratoconus. One patient with bilateral keratoconus had bilateral symmetric floppy eyelid syndrome. The other four patients had asymmetric keratoconus and floppy eyelid syndrome. In all four patients, the keratoconus was significantly worse in the eye with the more severe case of floppy eyelid syndrome. In addition, these four patients all gave a history of sleeping with their head facing predominantly on the side with the floppy eyelid syndrome and keratoconus. Two patients with keratoconus and floppy eyelid syndrome were able to undergo successful contact lens rehabilitation of their keratoconus after treatment of the floppy eyelid syndrome.

Adult↗
PubMed1994

Vascular anatomy of the eyelids.

PURPOSE: The eyelids have a rich vascular supply, and bleeding may compromise both surgical technique and postoperative results. Generally, it is known that the eyelids contain a marginal and peripheral arcade, but detailed anatomic information is not available. This study therefore was undertaken to determine the detailed anatomy of eyelid vascularity. METHOD: The common carotid arteries of six fresh cadaver heads were injected with a compound consisting of a partially polymerized monomer, to which a catalyst and promoter were added to cause hardening. The soft tissue was then digested, using 40% potassium hydroxide, to obtain detailed casts of the eyelid arteries, arterioles, and capillaries. RESULTS: The authors describe the eyelid vascularity and anastomotic network with average distance measurements from clinically relevant soft tissue landmarks in the 12 cadaver eyelids. CONCLUSIONS: Consistent patterns of eyelid vascularity were observed. A better understanding of the eyelid vascularity should allow modification of surgical techniques and reduce postoperative complications after eyelid surgery.

Carotid Artery, External↗
PubMed1999

Eyelid, conjunctival, and corneal findings in sleep apnea syndrome.

OBJECTIVE: To determine the prevalence of eyelid, conjunctival, and corneal findings in patients with sleep apnea syndrome (SAS). DESIGN: Case series. PARTICIPANTS: Seventy-two white patients referred for evaluation of suspected SAS. INTERVENTION: Complete examination of eyelids, conjunctiva, and cornea, including videokeratography. MAIN OUTCOME MEASURES: Spearman rank correlations were determined between the respiratory disturbance index (RDI) during night sleep, a value used to diagnose and grade SAS, and tear film break-up time, eyelid distraction distance, presence or absence of ocular irritation symptoms, blepharoptosis, floppy eyelids, lacrimal gland prolapse, keratoconus, and endothelial dystrophy. Each correlation was controlled for age and body mass index. RESULTS: According to the RDI, 44 (61 %) of the 72 patients had SAS. The RDI correlated positively with the eyelid distraction distance (P = 0.05), presence or absence of floppy eyelids (P = 0.01), and lacrimal gland prolapse (P = 0.01), and correlated negatively with tear film break-up time (P = 0.02). None of our patients with floppy eyelids had corneal abnormalities. One patient with SAS had bilateral keratoconus; another had bilateral Fuch endothelial dystrophy. CONCLUSIONS: Sleep apnea syndrome was significantly associated with reduced tear film break-up time, floppy eyelids, and lacrimal gland prolapse. However, ocular irritation symptoms and corneal involvement were rare among patients with SAS. These findings do not confirm previous studies that reported a high prevalence of corneal involvement in floppy eyelid syndrome.

Adult↗
PubMed2003

Malignant eyelid tumours in Taiwan.

AIMS: To describe the clinical characteristics of patients with eyelid cancers in Taiwan. METHODS: Between 1980 and 2000, 127 (58 males and 69 females) patients (mean age 62.6; range 10-91 years) with histologically confirmed eyelid cancers were retrospectively evaluated at the National Taiwan University Hospital and Far Eastern Memorial Hospital in Taiwan. Clinical data of all patients were reviewed from medical records. The mean follow-up period was 62.4 months (range 3-240) for 113 patients. RESULTS: The 127 eyelid cancers included 79 basal cell carcinomas (62.2%), 30 sebaceous gland carcinomas (23.6%), 11 squamous cell carcinomas (8.7%), five malignant melanomas (3.9%), one Kaposi's sarcoma (0.8%), and one metastatic cancer (0.8%). Tumours developed more commonly in the lower (37.0%) than the upper eyelid (33.9%). The clinical accuracy in predicting eyelid malignancy was 90.5%. Primary treatment modality was mainly surgical excision. The recurrence, metastasis, and mortality rates at 5 years were 15.2, 11.7, and 7.3%, respectively, for all eyelid malignancies. Rates of sebaceous gland carcinoma recurrence, metastasis, and mortality were significantly higher (P<0.05) than those of basal cell carcinoma. The mean interval of recurrence or metastasis after primary treatment was 26.3 months (range 4-112) for all eyelid cancers. CONCLUSIONS: Although basal cell carcinoma is the most common eyelid cancer in Taiwan, sebaceous gland carcinoma is also common. Of the two, basal cell carcinoma has a better prognosis and sebaceous gland carcinoma has a higher mortality and therefore should be treated much more aggressively. Long-term follow-up is needed after treatment of malignant eyelid tumours.

Adolescent↗
PubMed1999

Doxorubicin does not spread systemically following a local injection into the eyelids of rabbits.

PURPOSE: An experimental treatment for benign essential blepharospasm and hemifacial spasm involves the direct injection of doxorubicin into the eyelids to permanently kill muscle. This study examined the extent of local and systemic spread of doxorubicin after localized injections of low doses into the eyelid and determined the length of time doxorubicin was retained in the eyelid after injection. METHODS: Two mg doxorubicin was injected subcutaneously into the lower eyelids of rabbits. After various time periods, the eyelids were removed and dissected into three separate specimens consisting of skin, subcutaneous connective tissue including orbicularis oculi muscle, or palpebral conjunctiva. Nearby tissues were also collected, including facial muscles and extraocular muscles. Urine, blood, kidney, spleen, heart and liver samples were collected. All tissues were prepared for HPLC determination of doxorubicin concentration. RESULTS: Doxorubicin was detected in all three eyelid specimens for the first 4 days after injection, although by the fourth day the level of doxorubicin was greatly reduced. On and after the seventh day, there was no detectable doxorubicin in the treated eyelid tissues. There were no detectable levels of doxorubicin in the urine or any other body tissue at any of the post-injection intervals examined. There was no long term retention in any of the eyelid tissues examined. CONCLUSIONS: The well described array of serious systemic side effects caused by the use of high systemic doses of doxorubicin as a chemotherapeutic agent made it critical to ascertain how long doxorubicin remained within the injected eyelids, and to determine to what extent and with what time course local injections of chemically intact doxorubicin might spread systemically. The short retention of the active or unmetabolized drug at the injection site is important, since more than one set of injections has been required for satisfactory amelioration of muscle spasms in blepharospasm and hemifacial spasm patients. The lack of detectable systemic spread of the drug distant from the local site of injection as well as the lack of long term retention of the locally injected doxorubicin lends support for the safety of doxorubicin administered in this manner to blepharospasm and hemifacial spasm patients.

Animals↗
PubMed1994

Fused eyelids in premature infants.

The charts of 161 extremely premature newborns were reviewed to characterize and report the incidence of infants born with fused eyelids, to determine when postbirth eyelid dysjunction occurs, and to address the survivability of these infants. Logistic regression analysis was used to examine the relationship between various ophthalmic outcomes and possible predictors of these outcomes. For babies born with eyelids fused, Cox regression analysis was used to assess time to eyelid opening. From the analysis of our data, we found that the critical time for eyelid opening is between 25.5 and 26.5 weeks gestational age. If fused at birth, the average time to eyelid opening after birth was 5.5 days. Fifty-two percent of babies born with their eyelids fused survived to be discharged from the hospital, compared to 83% of those born with eyelids open. Gestational age was found to be the most important predictor of the status of the eyelids at birth, of survival, and of the presence of retinopathy of prematurity (ROP). Other variables were found to be significant, but the significance was lost once the variable was adjusted for gestational age.

Adult↗
PubMed2000

The geometrical basis of the eyelid contour.

PURPOSE: To derive a two-dimensional, frontal-view model of eyelid contour. METHODS: Observational study. Palpebral fissure images of 110 normal subjects were acquired with a charge-coupled device camera and processed with National Institutes of Health Image software on a Macintosh computer. Monocular frontal-view images of the palpebral fissures were recorded and second-degree polynomial functions were fitted to both upper and lower eyelid contours for two areas: the whole eyelid margin (ciliated and inner canthal portions) and the ciliated portion alone. In addition, frontal and lateral palpebral fissure images were obtained. From the frontal view, the upper and lower ciliated contours were fitted with quadratic functions. From the lateral view, the upper and lower lateral angles, formed by the upper and lower eyelid margins and the axial axis, were measured. RESULTS: Exclusion of the inner canthal portion of the eyelid contour led to a much better quadratic fit for the contours. The sine (sin) of the upper lateral angle was strongly correlated with the parameter A of the quadratic function fitted to the upper eyelid (the parameter A determines the curvature of the function around its extremum point). For the lower eyelid, this correlation was not significant. CONCLUSIONS: The parabolic shape of the upper ciliated contour seen in two-dimensional images can be justified geometrically in a simple way, allowing a precise quantification of its shape. The same was not true for the lower eyelid. The parabolic shape of the upper eyelid can be demonstrated, using the Taylor series, to be a close approximation of the arc of a circle.

Adolescent↗
PubMedDate not supplied

Secondary tarsoconjunctival flap after previous lower eyelid Hughes repair.

PURPOSE: To describe a secondary, two-stage eyelid-sharing tarsoconjunctival flap advancement technique for the repair of full-thickness lower eyelid defect, using the remaining upper eyelid marginal tarsus that was spared in a previously performed Hughes procedure. METHODS: A computerized database search was performed on all cases of Hughes repair of the lower eyelid performed over a 10-year period (1995 to 2005) to identify patients who required a secondary tarsoconjunctival flap repair. In two cases of tumour recurrence at the lower eyelid margin, an eyelid-sharing, two-stage tarsoconjunctival flap repair of the lower eyelid using the remaining 4 mm of marginal tarsus that was spared in the original Hughes procedure was performed. Case reports of these 2 patients are presented together with their postoperative results. RESULTS: The incidence rate of the described secondary tarsoconjunctival flap procedure was 2 cases per 240 cases (0.8%) of primary Hughes procedure performed over a 10-year period. The postoperative courses in the 2 patients were uncomplicated with excellent surgical results at 6 months' follow-up. CONCLUSIONS: The secondary tarsoconjunctival flap advancement procedure is an effective reconstructive technique for the repair of the full-thickness lower eyelid defect in an eyelid that has already undergone a previous Hughes repair.

Aged↗
PubMed2005

Basal cell carcinoma of the eyelid in Finland during 1953-97.

PURPOSE: To study the incidence of basal cell carcinoma (BCC) of the eyelid in Finland. METHODS: We studied 6241 cases of BCC of the eyelid reported to the nationwide Finnish Cancer Registry during 1953-97. We determined the age- and sex- specific incidence rates and overall rates adjusted for age to the world standard population, and social class- and occupation-specific standardized incidence ratios, with the total Finnish population as reference. RESULTS: The incidence rates of BCC of the eyelid varied between 0.7 and 3.0 per 100 000 person-years in men and between 0.5 and 2.8 per 100 000 person-years in women during the study period. The age-adjusted incidence rates of BCC of the eyelid increased during 1953-87 (p < 0.0001). The incidence of BCC of the eyelid rose significantly with age. There were no significant differences in standardized incidence ratios (SIRs) for BCC of the eyelid between different social class and occupation categories. CONCLUSION: Age-adjusted incidence rates showed that BCC of the eyelid was more than twice as frequent during 1978-97 than before 1968. Ageing may partly explain the increased incidence of BCC of the eyelid, whereas there were no differences in the SIRs for BCC of the eyelid between different social class and occupation categories in Finland.

Adolescent↗
PubMed2006

The aetiology of eyelid dermatitis: a 10-year retrospective analysis.

Few studies have examined the aetiology of eyelid dermatitis across broad demographics. The objectives of this study were (i) to compare the diagnoses of patients with isolated eyelid dermatitis to the diagnoses of patients with additional sites of involvement and (ii) to determine the relevant allergens among patients with allergic eyelid dermatitis. A retrospective analysis of 1215 patients patch tested over 10 years was conducted in this study. Compared to patients without eyelid dermatitis, patients with this entity were more often female. Of the 105 patients with eyelid dermatitis, 43.8% had allergic contact dermatitis (ACD), 36.2% seborrhoeic dermatitis, 11.4% other dermatitis/dermatoses, 7.6% irritant contact dermatitis, 3.8% psoriasis, and 2.9% atopic eczema. With isolated eyelid dermatitis, seborrhoeic dermatitis was the most frequent diagnosis (46.3%) followed by ACD (35.2%). Allergens commonly causing allergic eyelid dermatitis consisted of fragrances, metals, neomycin, oleamidopropyl dimethylamine, tosylamide formaldehyde resin, benzalkonium chloride, and other preservatives. When evaluated according to sites of involvement, seborrhoeic dermatitis was diagnosed most often in patients with isolated eyelid dermatitis, but when dermatitis was distributed to facial or other sites, ACD was the most frequent diagnosis. A majority of the causative allergens for eyelid dermatitis are not present on the Food and Drug Administration-approved panels available in the USA.

Adolescent↗
PubMed2000

Neurophysiological aspects of eye and eyelid movements during blinking in humans.

The neural relationships between eyelid movements and eye movements during spontaneous, voluntary, and reflex blinking in a group of healthy subjects were examined. Electromyographic (EMG) recording of the orbicularis oculi (OO) muscles was performed using surface electrodes. Concurrently, horizontal and vertical eye positions were recorded by means of the double magnetic induction (DMI) ring method. In addition, movement of the upper eyelid was measured by a specially designed search coil, placed on the upper eyelid. The reflex blink was elicited electrically by supraorbital nerve stimulation either on the right or the left side. It is found that disconjugate oblique eye movements accompany spontaneous, voluntary as well as reflex blinking. Depending on the gaze position before blinking, the amplitude of horizontal and vertical components of the eye movement during blinking varies in a systematic way. With adduction and downward gaze the amplitude is minimal. With abduction the horizontal amplitude increases, whereas with upward gaze the vertical amplitude increases. Unilateral electrical supraorbital nerve stimulation at low currents elicits eye movements with a bilateral late component. At stimulus intensities approximately two to three times above the threshold, the early ipsilateral blink reflex response (R(1)) in the OO muscle can be observed together with an early ipsilateral eye movement component at a latency of approximately 15 ms. In addition, during the electrical blink reflex, early ipsilateral and late bilateral components can also be identified in the upper eyelid movement. In contrast to the late bilateral component of upper eyelid movement, the early ipsilateral component of upper eyelid movement appears to open the eye to a greater degree. This early ipsilateral component of upper eyelid movement occurs more or less simultaneously with the early eye movement component. It is suggested that both early ipsilateral movements following electrical stimulation do not have a central neural origin. Late components of the eye movements slightly precede the late components of the eyelid movement. Synchrony between late components of eyelid movements and eye movements as well as similarity of oblique eye movement components in different types of blinking suggest the existence of a premotor neural structure acting as a generator that coordinates impulses to different subnuclei of the oculomotor nucleus as well as the facial nerve nucleus during blinking independent from the ocular saccadic and/or vergence system. The profile and direction of the eye movement rotation during blinking gives support to the idea that it may be secondary to eyeball retraction; an extra cocontraction of the inferior and superior rectus muscle would be sufficient to explain both eye retraction and rotation in the horizontal vertical and torsional planes.

Adult↗
PubMed1986

Eyelid development and fusion induced by cortisone treatment in mutant, lidgap-Miller, foetal mice. A scanning electron microscope study.

In normal mice the eyelids grow across the eye and fuse together during days 15 and 16 of gestation, and the mice are born with their eyes closed. In mutant lgMl)/lgMl) (lidgap-Miller) foetuses this growth and fusion does not occur and the mice are born with their eyes open. A single prenatal treatment with cortisone on day 14 of gestation masks the genetic defect, and the mice are born with their eyes closed. In the present study, a scanning electron microscope was used to investigate: whether eyelid closure in cortisone-treated lgMl/lgMl foetuses differs from that in normal foetuses of the CBA/J and ICR/Ml strains and, if so, how; and off developing eyelids of untreated lgMl/lgMl foetuses differ from normal. The induced closure differs from normal. During their growth, eyelids of treated mutant foetuses have a deficiency of rounded periderm cells at their margins; the margin cells agglomerate and flatten prematurely. In closed eyes of treated mutants there is a gap between periderm cells of the upper and lower eyelids along part of the fusion line. Fusion is completed late, during day 17. Maturation of the head periderm is advanced in treated lgMl/lgMl foetuses on day 16, relative to normal CBA/J and untreated lgMl/lgMl foetuses. Untreated lgMl/lgMl foetuses differ from normal in that the eyelids never cover the eye and lack rounded periderm cells at their perimeter. The periderm cells present form a flattened band along the eyelid margin rather than, as in normal eyelids, along the fusion line. The results of the cortisone study suggest that the route to eyelid closure in mice may not be narrowly canalized either in cell morphology or number, or in timing, and that closed eyes may be achieved after cortisone treatment in lgMl/lgMl foetuses as part of an induced maturation of the periderm.

Animals↗
PubMed1993

Eyelid development, fusion and subsequent reopening in the mouse.

The process of eyelid development was studied in the mouse. The critical events occur between about 15.5 d postcoitum (p.c.) and 12 d after birth, and were studied by conventional histology and by scanning electron microscopy. At about 15.5 d p.c. the cornea of the eye is clearly visible with the primitive eyelids being represented by protruding ridges of epithelium at its periphery. Over the next 24 h, eyelid development proceeds to the stage when the cornea is completely covered by the fused eyelids. Periderm cells stream in to fill the gap between the developing eyelids. Their proliferative activity is such that they produce a cellular excrescence on the outer surface of the line of fusion of the eyelids. This excrescence had almost disappeared by about 17.5 d p.c. Keratinisation is first evident at this stage on the surface of the eyelids and passes continuously from one eyelid to the other. Evidence of epidermal differentiation is more clearly seen in the newborn, where a distinctive stratum granulosum now occupies about one third of its entire thickness. Within the subjacent dermis, hair follicles are differentiating. By about 5 d after birth, a thick layer of keratin extends without interruption across the junctional region. While a noticeable surface indentation overlies the latter, a similar depression is only seen on the conjunctival surface by about 10 d after birth. Keratinisation is also observed to extend in from the epidermal surface to involve the entire region between the 2 eyelids at about this time.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Eyelid opening induces expression of a glycocalyx glycoprotein of rat ocular surface epithelium.

PURPOSE: We previously characterized a monoclonal antibody against a glycoprotein of rat ocular surface glycocalyx (ROSG). This monoclonal antibody recognizes a carbohydrate epitope on a glycoprotein expressed in apical cells of the differentiated ocular surface epithelium. Our goal was to determine the developmental appearance of the ROSG glycoprotein. METHODS: We localized the antigen immunohistochemically and immunocytochemically in newborn (day 1) rats and in rats 2-5, 7, and 11-15 days after birth. RESULTS: Before eyelid opening (days 12-14), the ROSG antigen was localized in the palpebral conjunctiva near the lid margin. The binding extended to layers of the subapical flattened cells. However, the antigen was not found in the corneal epithelium while the eyelid remained closed. In contrast, at the first day of eyelid opening (days 12-15), the antigen was present contiguously in several cell layers from the eyelid margin along the entire ocular surface, including the corneal epithelium. Thus, the binding pattern seen upon eyelid opening was similar to that of adult rats. The phenomenon of appearance of the glycoprotein upon eyelid opening was further demonstrated in rats with asynchronous eyelid opening. Artificial, premature eyelid opening at days 8-11 also induced the expression of the antigen along the entire ocular surface epithelium, similar to the binding in naturally opened eyes. CONCLUSION: Eyelid opening may induce glycosylation or expression of a glycocalyx component that we hypothesize to be involved in mucin spread.

Animals↗
PubMed1996

Use of a modified monocanalicular silicone stent in 33 eyelids.

BACKGROUND AND OBJECTIVE: To determine (1) whether a modified monocanalicular silicone stent fixated to the peripunctal tissues by a 6-0 polypropylene suture is a practical alternative to bicanalicular intubation for canalicular reconstruction, and (2) whether this technique is superior to previously described methods of monocanalicular intubation. PATIENTS AND METHODS: The charts of patients from the Oculoplastics Division of the Ophthalmology Department at the UMDNJ Medical School who had undergone insertion of a modified canalicular stent were retrospectively reviewed from April 1, 1991, to April 1, 1995. RESULTS: The technique was used successfully in 33 eyelids (32 patients) for the following conditions: (1) unicanalicular (17 eyelids) and bicanalicular lacerations (1 eyelid), (2) reconstruction of a single canaliculus after eyelid tumor resection (5 eyelids), (3) after canaliculotomy for canaliculitis refractory to medical treatment (3 eyelids), and (4) after punctal plasty for congenital punctal agenesis and after a three-snip procedure for acquired punctal stenosis (6 eyelids). Tubes were maintained in position for a median of 11.5 weeks. Complications included erosion of the anterior aspect on the lid margin (1 eyelid) and premature tube extrusion (1 eyelid) that required reinsertion of another monocanalicular stent. All patients had normal results on dye disappearance tests after surgery and no patients experienced postoperative tearing. CONCLUSIONS: The monocanalicular silicone stent is technically simple to perform and is an effective method of monocanalicular intubation that may avoid the need for bicanalicular intubation in certain circumstances.

Adult↗
PubMed1995

Palpebral fissure height and downgaze in patients with Graves upper eyelid retraction and congenital blepharoptosis.

PURPOSE: To compare the relation between vertical eyelid fissure height and downgaze in healthy subjects and in patients with Graves upper eyelid retraction and congenital blepharoptosis. METHODS: With a caliper rule, the authors measured the vertical eyelid fissure height of 25 patients with no previous history of eye disease, 34 patients with Graves disease, and 16 patients with congenital blepharoptosis. All measurements were done at the primary position and at four levels of downgaze (10 degrees, 20 degrees, 30 degrees, and 40 degrees). In 13 patients with Graves disease, vertical phoria was quantified with a Maddox rod and prism. RESULTS: The relation between vertical eyelid fissure height and downgaze is linear. The slope was identical for the control subjects and for the patients with Graves disease (b = -1.36) but it was almost zero for the patients with congenital blepharoptosis (b = -0.037). When vertical eyelid fissure height was corrected to arc values, the slope of the relation between vertical eyelid fissure height and downgaze was significantly greater for the patients with Graves disease. Vertical phoria was not related to the amount of Graves upper eyelid retraction. CONCLUSIONS: The data support the hypotheses that upper eyelid retraction secondary to Graves eye disease results from hyperactivity of the levator palpebrae superioris muscle.

Adolescent↗
PubMed1995

'Henderson's' relief of eyelid retraction revisited.

The purpose of the study was to identify those patients with thyroid eye disease and upper eyelid retraction who would benefit from Henderson's procedure (myotomy of Muller's superior tarsal muscle with graded division of levator aponeurotic fibres on the anterior tarsal plate). The clinical records of patients attending the Thyroid Clinic of Moorfields Hospital who had undergone Henderson's procedures were reviewed. Twenty-two patients (19 women, 3 men) had Henderson's procedures at age 35-69 years (mean 49.9), with a mean follow-up of 4.55 years. Eleven patients had bilateral upper eyelid surgery, 11 unilateral (33 eyelids). The pre-operative vertical palpebral apertures ranged from 11 to 19 mm (mean 13.95); the post-operative vertical palpebral apertures ranged from 8 to 15 mm (mean 11.45), a mean reduction of 2.5 mm (p < 0.001). Eight of twenty-two patients (36%) had further eyelid surgery and 3 of 22 (14%) had further surgery recommended because of persistent upper eyelid retraction, abnormal eyelid contour (lateral flare) and asymmetry. It is concluded that Henderson's procedure should be reserved for those patients with minor degrees of almost symmetrical upper eyelid retraction who do not have abnormalities of their eyelid contour.

Adult↗