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October 1995

Loss of Vertical Palpebral Fissure Height on Downgaze in Acquired Blepharoptosis

Author Affiliations

From the Departments of Ophthalmology, Sinai Hospital, Detroit (Dr Olson); William Beaumont Hospital, Royal Oak (Dr Olson), Mich; the Department of Ophthalmology, University of Illinois at Chicago College of Medicine (Dr Putterman); and Michael Reese Hospital and Medical Center, Chicago (Dr Putterman). Dr Olson is currently in private practice in Westport, Conn.

Arch Ophthalmol. 1995;113(10):1293-1297. doi:10.1001/archopht.1995.01100100081033

Objective:  To determine criteria to diagnose and document functional visual impairment from upper eyelid ptosis in the downgaze position of reading.

Design:  Prospective clinical study.

Patients:  From September 1991 to June 1992, 47 consecutive patients with adult-onset acquired ptosis were enrolled in the study. Downgaze eyelid and relative brow position were evaluated in 88 eyelids of these patients.

Interventions:  Surgical repair of blepharoptosis by the Müller muscle conjunctival resection ptosis procedure, levator aponeurosis advancement and/or resection, or levator muscle resection.

Main Outcome Measure:  Postoperative change in the eyelid and brow position in downgaze.

Results:  Of all ptotic eyelids, 43% had zero vertical palpebral fissure height in downgaze when the brows were relaxed and therefore were functionally blind in the downgaze position. After ptosis repair, there was a significant widening of the vertical palpebral fissure height in downgaze (P<.001), a significant decrease in frontalis muscle use (P<.001), and return of the patients' ability to sustain downgaze function.

Conclusions:  Measurement of palpebral fissure height in downgaze and frontalis muscle use in patients with acquired ptosis identifies patients with a functional visual deficit in the downgaze reading position. These measurements can be easily performed in the office and may be added to criteria for documenting functional impairment from blepharoptosis.

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