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At least 19 recordsLinked to original sources
PubMed1999

Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery.

OBJECTIVE: To assess the effect of blepharoptosis on patients' visual function and health-related quality of life and to determine what measures are associated with postsurgical change in functional status. DESIGN: Prospective, observational case series. PARTICIPANTS: One hundred patients with unilateral or bilateral blepharoptosis. INTERVENTION/MAIN OUTCOME MEASURES: Preoperative and postoperative upper eyelid position (i.e., margin reflex distance [MRD]) and superior visual field (SVF) height, as well as subjective visual function and health-related quality-of-life functional status before and after ptosis surgery. RESULTS: There was a mean 30-point increase in functional index score after ptosis repair (P < 0.001). Lower (more ptotic) preoperative upper eyelid position and SVF (combined eye) were associated with greater change in functional index after surgery (r = -0.290, P = 0.007 and r = -0.39, P = 0.003, respectively). Preoperative visual field testing with manual lid elevation was not significantly correlated to the postoperative change in functional index (P > 0.100). The strongest correlation of postoperative functional index change was with the preoperative functional status (r = -0.79, P < 0.001). CONCLUSIONS: Patients' functional status is reduced by blepharoptosis, and surgical repair results in measurable increase in health-related quality of life. Patients' self-reported preoperative functional impairment is most strongly associated with the degree of postsurgical functional improvement.

Adult↗
PubMed2003

Congenital blepharoptosis: Part II. Visual disorders coexisting with congenital blepharoptosis.

A retrospective ophthalmic analysis 44 of 118 patients with congenital blepharoptosis aged from 2 to 48, who underwent surgical correction at the Department of Plastic Surgery of Lódź between 1977 and 2001, was reviewed. Patients with congenital blepharoptosis were investigated by ophthalmologists in the pre and postoperative period, and their medical ophthalmological notes were also analysed. The aim of this study was to assess the presence, type, and severity of visual disorders coexisting with ptosis. We found in 42 patients (95%) ophthalmologic disorders, of which we noted amblyopia in 19, astigmatism in 30, anisometropia in 5, and strabismus in 30 cases.

Adolescent↗
PubMed2003

Congenital blepharoptosis: Part I. Evaluation of the results of surgical treatment for congenital blepharoptosis.

A retrospective clinical analysis of 69 of 118 patients with congenital blepharoptosis aged from 2 to 48, who underwent surgical corrections at the Department of Plastic Surgery of Lódź between 1977 and 2001, was reviewed. Included cases were analysed on the base of the type of primary defect, degree of ptosis, and surgical method. The aim of this study was to estimate aesthetic and functional results of surgical treatment in 39 patients corrected by Mustarde's modified method, in 17 by Mustarde's method, in 7 by Everbusch's method, in 4 by Blascovic's method, and in 2 by frontalis suspension. Comparable acceptable results of Mustarde's modified and Mustarde's method were achieved. Postoperatively 13 patients (18.8%) exhibited lagophthalmos.

Adolescent↗
PubMed2001

Upper eyelid motility in blepharoptosis and in the aging eyelid.

PURPOSE: To study the metrics of lid saccades in blepharoptosis and to distinguish any differences in the dynamics of eyelid movements that are related to the cause of blepharoptosis and to aging. METHODS: The lid and vertical eye saccades of 7 patients with congenital blepharoptosis and those of 18 patients with aponeurogenic blepharoptosis, either involutional or rigid-contact-lens-induced, were recorded with electromagnetic search coils. For each saccade, two parameters were assessed: amplitude and peak velocity. Two age-matched control groups were assessed in the same manner. Repeated measures analysis of variance was used to investigate any observed differences between the included groups. RESULTS: Congenital and rigid-contact-lens-induced blepharoptosis were readily distinguishable from one another, as well as from the age-matched control group, in both lid saccadic amplitude and peak velocity. For example, 40 degrees downward lid saccades in the congenital blepharoptosis group averaged 22.9 degrees +/- 4.0 degrees (SD), whereas 30.0 degrees +/- 4.7 degrees lid saccades were made by the age-matched control group. The subjects in the two groups with aponeurogenic blepharoptosis also made lid saccades that were distinctive for their group (P: < 0.02), in both amplitude and peak velocity. For 40 degrees downward saccades in involutional and rigid-contact-lens-induced blepharoptosis, lid saccadic amplitude averaged 32.7 degrees +/- 4.3 degrees and 40.3 degrees +/- 3.5 degrees, respectively. Lid saccadic peak velocity declined significantly with age. Lid saccadic peak velocity for 40 degrees upward saccades in the younger control group averaged 401.7 +/- 11.4 deg/sec, whereas the older control group achieved an average peak velocity of 360.7 +/- 60.4 deg/sec. The lid saccadic dynamics in the involutional blepharoptosis group proved to be similar (P: > 0.05) in saccadic amplitude and peak velocity to those of age-matched controls. CONCLUSIONS: In different forms of blepharoptosis, distinctive metrics of lid saccades occur. The current data suggest that involutional blepharoptosis is not a consequence of normal age-related changes in eyelid function.

Adult↗
PubMed2004

Ultrasound biomicroscopy of the levator aponeurosis in congenital and aponeurotic blepharoptosis.

PURPOSE: To evaluate and measure the thickness of the levator aponeurosis by ultrasound biomicroscopy in congenital dysmyogenic and aponeurotic blepharoptosis. METHODS: Forty-four upper eyelids of 22 patients who had unilateral blepharoptosis were evaluated by ultrasound biomicroscopy. The patients ranged in age from 13 to 69 years (mean, 35.4 +/- 20.2 years). Fourteen patients were male and 8 patients were female. Seven patients had congenital dysmyogenic blepharoptosis and 15 patients had aponeurotic blepharoptosis. Imaging was performed with a 50-MHz transducer. The thickness of the levator aponeurosis was measured centrally at the upper border of the tarsus. RESULTS: The levator aponeurosis was imaged in all eyelids except for one eyelid with aponeurotic blepharoptosis. The mean thickness of the levator aponeurosis was 0.39 +/- 0.10 mm in the ptotic eyelid and 0.42 +/- 0.09 mm in the control eyelid of the patients with congenital dysmyogenic blepharoptosis (p = 0.043). The mean thickness of the levator aponeurosis was 0.26 +/- 0.05 mm in the ptotic eyelid and 0.36 +/- 0.04 mm in the control eyelid of the patients with aponeurotic blepharoptosis (p = 0.001). The thickness of the levator aponeurosis was correlated with the palpebral fissure height (p = 0.013, r = 0.644) in aponeurotic blepharoptosis. The thickness of the levator aponeurosis was correlated with the levator function (p = 0.033, r = 0.795) in congenital dysmyogenic blepharoptosis. CONCLUSIONS: The thickness of the levator aponeurosis can be measured with ultrasound biomicroscopy. The most common pathology in aponeurotic blepharoptosis is thinned-out aponeurosis. The levator aponeurosis of the ptotic eyelid is thinner than the normal eyelid in congenital ptosis.

Adolescent↗
PubMed1992

Detection of contralateral eyelid retraction associated with blepharoptosis.

The association between induced contralateral upper eyelid retraction and blepharoptosis, although well known, has not been well analyzed. The authors prospectively studied 50 consecutive patients with blepharoptosis. Interpalpebral fissure measurements of the contralateral "normal" or relatively less blepharoptotic eyelids were made in the resting position, with the blepharoptotic eye occluded, manually elevated, and after instillation of phenylephrine 2.5%. Ocular dominance also was tested. Contralateral interpalpebral fissure height decreased greater than or equal to 1 mm in 10 of 50 patients (20%) after manual elevation. Blepharoptosis was present or greater in the dominant eye in 7 of 10 (70%) patients in this group, but in only 7 of 40 (18%) patients in the group not showing such a response (P less than 0.001). Of 12 patients with congenital blepharoptosis, none demonstrated this response. In patients with acquired blepharoptosis, contralateral decrease in eyelid position also was directly associated with severity of blepharoptosis in the opposite eye. These findings suggest that contralateral induced eyelid elevation or retraction is frequently associated with blepharoptosis and is more apparent as visual impairment secondary to blepharoptosis increases. Detection of contralateral eyelid retraction is important in the preoperative evaluation of blepharoptosis.

Adolescent↗
PubMed1993

Evaluating the visual field effects of blepharoptosis using automated static perimetry.

BACKGROUND: Quantitation of the effects of blepharoptosis on the visual field has largely been limited to manual kinetic perimetry using a single peripheral isopter. The authors evaluated the visual dysfunction caused by blepharoptosis using automated static full-threshold perimetry. METHODS: A custom static full-threshold 60 degrees test strategy on the Humphrey field analyzer was used to assess the visual fields of 20 volunteers at their normal baseline and after inducing mild and moderately severe blepharoptosis by applying gold weights to the eyelids. Threshold sensitivities were measured at points along the eight principal meridians, separated by 45 degrees, traditionally used to assess visual field impairment. RESULTS: For mild blepharoptosis, essentially all test points along the superior meridian were significantly depressed (P < 0.01), with an increase in slope secondary to greater decreases in sensitivity at more eccentric points. For moderately severe blepharoptosis, depression of the superior meridian was expectedly greater than that seen with mild blepharoptosis. Additionally, depression of the horizontal meridians and to a lesser extent the lower meridians also was noted. CONCLUSIONS: These results suggest that even mild blepharoptosis may be associated with depression of the superior visual field extending close to fixation. Ophthalmologists should be aware of the effect of blepharoptosis when testing for other ophthalmic or neurologic disorders using automated static perimetry. Full-threshold static perimetry can be used to quantitate the visual field loss associated with blepharoptosis as a means of evaluating visual impairment.

Adult↗
PubMed1993

Whitnall's sling with superior tarsectomy for the correction of severe unilateral blepharoptosis.

The management of severe unilateral blepharoptosis is problematic. In the presence of poor levator function, conventional surgical techniques frequently do not adequately elevate a ptotic eyelid. From May 1988 through July 1991, we used 4- to 5-mm external resections of the superior tarsus in conjunction with a maximal aponeurectomy (Whitnall's sling procedure) to augment blepharoptosis correction in selected cases of severe unilateral blepharoptosis. Seventeen (68%) of 25 patients with poor levator function blepharoptosis who underwent this new surgical procedure achieved a lid height within 1 mm of the opposite lid with good or excellent ocular function, cosmesis, and eyelid crease formation. Mild to moderate degrees of exposure keratopathy developed early in the postoperative period in all patients. This exposure keratopathy ultimately resolved in most patients. Superior tarsectomy safely augments the blepharoptosis correction of a Whitnall sling procedure in severe blepharoptosis, improving the results of aponeurotic surgery in patients with severe unilateral blepharoptosis.

Adolescent↗
PubMed2003

Blepharoptosis correction.

Blepharoptosis is a common complaint of eyelid malposition in which the upper eyelid is lower than normal. There are multiple types of blepharoptosis based on cause, and important studies have recently been published on one type, myogenic blepharoptosis. There have classically been three methods for correcting blepharoptosis. For the most severe cases, frontalis slings are often performed. New materials, such as polyester mesh, have shown promise as alternatives in forming frontalis slings. A recent paper has suggested a new algorithm for another method of blepharoptosis correction, the conjunctiva-Müller muscle resection. The effectiveness of the third type of procedure for blepharoptosis correction, the external levator advancement, has been reinforced in a study examining the procedure in cases of congenital blepharoptosis.

Blepharoplasty↗
PubMed1992

Visual field loss in primary gaze and reading gaze due to acquired blepharoptosis and visual field improvement following ptosis surgery.

Acquired blepharoptosis has been associated with loss of the superior visual field (SVF) in primary gaze. Because many patients with acquired blepharoptosis complained of difficulty reading or performing other visual functions in reading gaze, a prospective study was undertaken to determine if acquired blepharoptosis was the cause of these visual dysfunctions. Preoperative and postoperative SVFs were tested in primary gaze and reading gaze in 19 patients with unilateral or bilateral acquired blepharoptosis totaling 30 eyes. Preoperative testing revealed a marked loss of the SVF in both primary gaze and reading gaze. All patients underwent levator aponeurosis defect repair. Postoperative results showed a significant improvement in both primary and reading gaze SVFs. Therefore, patients with good visual acuity complaining of difficulty reading or carrying out other visual functions in reading gaze should be examined for the presence of acquired blepharoptosis. Blepharoptosis repair can be expected to improve the SVF in both primary gaze and reading gaze.

Adult↗
PubMed1977

Anterior tarsectomy reoperation for upper eyelid blepharoptosis or contour abnormalities.

In five cases, a simplified anterior tarsal resection corrected complicated upper eyelid blepharoptosis and contour abnormalities. One case of residual blepharoptosis after levator muscle resection was corrected by resecting an amount of tarsus equal to the desired amount of correction. Two cases of upper eyelid blepharoptosis resulting from overcorrected levator muscle recession were corrected in the same manner. In one case of residual segmental blepharoptosis of the upper eyelid causing a contour abnormality, we resected a segment of tarsus corresponding to the amount of blepharoptosis in the affected segment of the eyelid. In one patient who developed a contour abnormality after a Fasanella procedure with segmental blepharoptosis nasally and overcorrection temporally, a segment of tarsus resected nasally and inserted temporally created an even contour. Anterior tarsal resection is a simple method of revising the upper eyelid level of contour in situations where the upper eyelid anatomy has been distorted by previous surgery.

Adult↗
PubMed1996

Improvement in subjective visual function and quality of life outcome measures after blepharoptosis surgery.

PURPOSE: To examine patients' subjective perception of visual function and health-related quality of life as affected by blepharoptosis and the change in these perceptions after blepharoptosis surgery. METHODS: A 27-item questionnaire pertaining to vision-related activities and symptoms was used preoperatively to assess 50 consecutive patients (18 years old or older) with unilateral or bilateral acquired involutional blepharoptosis, and postoperatively six to eight weeks after blepharoptosis repair. RESULTS: Of the 24 items statistically analyzed, 16 items (67%) demonstrated significant improvement postoperatively (P < .05) among the unilateral cases and 18 items (75%) showed significant improvement postoperatively (P < .05) among the bilateral cases. The four activities that improved the most after surgery for both the unilateral and bilateral groups were the ability to perform fine manual work, hanging or reaching objects above eye level, watching television, and reading. CONCLUSIONS: Surgical repair of acquired involutional blepharoptosis resulted in significant improvement in several aspects of patients' subjective visual function and health-related quality of life. These issues are important in determining both the indications for and outcome of blepharoptosis surgery.

Adult↗
PubMed1998

Digital image processing measurement of the upper eyelid contour in Graves disease and congenital blepharoptosis.

OBJECTIVE: This study used image processing techniques to quantify the upper eyelid contour of patients with Graves upper eyelid retraction and congenital blepharoptosis. DESIGN: The study design was a cross-sectional study. PARTICIPANTS: A total of 29 patients with Graves disease, 22 patients with congenital blepharoptosis, and 50 patients with no history of eye disease participated. INTERVENTION: The images of the palpebral fissure of all participants were transferred to a personal computer and processed with NIH Image 1.55 software. MAIN OUTCOME MEASURES: The following parameters were analyzed: the curvature of the upper eyelid contour, the position of the contour peak relative to the midline, and the ratio between the temporal and nasal upper quadrant areas of the palpebral fissure. RESULTS: All upper eyelid contours could be fitted with second-degree polynomial functions. The mean temporal/nasal area ratio was 1.33 mm in patients with Graves disease, 0.92 mm in patients with blepharoptosis, and 1.04 mm in control subjects. The peak of the upper eyelid contour was found to be lateral to the midline in control subjects (1.05 mm) and in patients with Graves disease (2.09 mm). In patients with blepharoptosis, the peak was 0.69 mm medial to the midline. Overall, the distance between the midpupil and the upper eyelid margin was correlated with several factors: the degree of curvature, the position of the peak of the eyelid contour, and the temporal/nasal area ratio. CONCLUSIONS: In Graves eyelid retraction, the curvature of the upper eyelid is enhanced, the peak of the contour is displaced laterally, and the temporal upper quadrant area is increased. Conversely, in congenital blepharoptosis, the eyelid is almost flat, the peak of the contour is displaced medially, and the upper quadrant area is diminished. The lateral segment of the upper eyelid is more involved than the nasal segment in both Graves upper eyelid retraction and congenital blepharoptosis.

Adolescent↗
PubMed2003

Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis.

PURPOSE: To evaluate, in patients with acquired good-function blepharoptosis, levator advancement success and surgical failure risk factors. METHODS: This retrospective, case-cohort study was university based. An estimated 828 patients underwent levator advancement for acquired good-function blepharoptosis between January 1, 1990, and December 31, 1999. Seventy-two patients underwent reoperation during the first postoperative year. Of 125 randomly selected patients not undergoing reoperation, 106 met the desired outcome criteria: postoperative margin reflex distance (MRD) >/=2.0 mm and </=4.5 mm in operated eyes and </=1.0 mm asymmetry between eyelids. Mean MRD, levator function, and Hering dependence (ipsilateral eyelid elevation exacerbating contralateral blepharoptosis) prevalence were determined for reoperated and desired-outcome groups and compared by using 2-sample t test and the Fisher exact test, respectively. Multivariate analysis was also performed. RESULTS: Reoperative rates were 8.7% overall, 5.2% of unilateral, and 13% of bilateral cases. Fourteen percent of patients had results outside the desired range but declined reoperation. Univariate analysis revealed significant differences in preoperative characteristics between desired and undercorrected groups: MRD, 1.0 versus 0.32 mm (p=0.001); levator function, 15.4 versus 14.7 mm (p=0.013); and Hering dependence, 50% versus 79% (p=0.005). With multivariate analysis, bilateral blepharoptosis was statistically significant (p=0.014), whereas levator function and Herring dependence were not. No differences were seen between desired and overcorrected groups. CONCLUSIONS: After levator advancement for acquired good-function blepharoptosis, 77% of patients had ideal results and 8.7% underwent reoperation. Patients with bilateral or severe blepharoptosis have increased risk of undercorrection.

Adult↗
PubMed2003

Blepharoptosis in Ibadan, Nigeria.

OBJECTIVE: To look into the cases of blepharoptosis in our environment as well as find out the causes and effects of the ptosis. DESIGN: Prospective clinic study and prospective cluster sampling method of school children. SETTING: University College Hospital, Ibadan and 3 schools in Ibadan, Nigeria. SUBJECT: Over a 5 year period, all patients who presented with blepharoptosis at the University College Hospital were recruited for the study. During the same period, a school survey was also done to find out the prevalence of blepharoptosis among school children. RESULTS: Twenty five cases of blepharoptosis were found during the 5 year period. Fifty two percent of the patients were found to be less than 16 years of age while only 8% were over 50 years of age. There was a 1:1 male to female ratio with majority of them (68%) having only one eye affected. The most common cause of blepharoptosis was found to be congenital, accounting for 56% of the patients. The prevalence in the school survey was found to be 1.2% higher than the incidence of 0.5% found in the eye clinic. CONCLUSION: Blepharoptosis is not an uncommon ocular problem. A detailed assessment of the cause, amount of ptosis and levator functions helps to determine the most appropriate surgical technique which would give the best functional and cosmetic result.

Adolescent↗
PubMed2003

[The role of releasing the fibrous bundles across levator muscle in correcting congenital blepharoptosis].

OBJECTIVE: To investigate the role of releasing the fibrous bundles across the levator muscle between the medial canthus and lateral canthsus near the top of tarsus in the correction of the congenital blepharoptosis. METHODS: Twenty-seven patients with 40 eyes of blepharoptosis were undergoing the treatment. It was performed by releasing the fibrous bundles across the levator muscle between the medial canthus and lateral canthsus near the top of tarsus to correct the mild and moderate blepharoptosis. A further procedure can also be added to by folding the levator aponeurosis if necessary. In the severe blepharoptosis, the frontalis aponeurose flap may be applied for the suspension as well during the operation. RESULTS: Of the 40 eyes in 27 cases with mild, moderate and severe blepharoptosis were treated by using this method, with 38 eyes corrected satisfactorily and 2 eyes corrected mostly in the following-ups from 3 months to 1 year. CONCLUSION: The above mentioned technique may be a good, simple and effect method to corret congenital blepharoptosis.

Adolescent↗
PubMed1981

Acquired blepharoptosis secondary to contact-lens wear.

Five patients (eight eyelids) had acquired blepharoptosis after using contact lenses. The ages (26 to 55 years) of these patients was not consistent with idiopathic senile blepharoptosis, and we excluded all other possible causes. All patients had disinsertion and recession of the aponeurosis of the levator palpebrae superioris muscle, and the blepharoptosis improved in each case after reattachment of the aponeurosis to the superior tarsal border. We believe there is a cause-and-effect relationship between the use of contact lenses and the acquisition of secondary blepharoptosis. The most likely explanation of this type of blepharoptosis is difficulty in inserting and removing the lenses. Thus, excessive eyelid manipulation may disinsert the aponeurosis of the levator palpebrae superioris muscle from the tarsus.

Adult↗