I read with interest the article by Drs Olson and Putterman.1 In the discussion of their article they stated, "Unlike other investigators, we believe that frontalis muscle use is enlisted in downgaze... " in reference to my article.2 They seem to imply that I do not believe that the frontalis muscle is used in patients with ptosis or in downgaze. I am puzzled as to why they state this, since I certainly did not make this statement anywhere in the article to which they refer. The concept of patients with ptosis using the frontalis muscle to elevate the eyelids is well documented and indeed the basis for ptosis repair with a sling. In my article, which is the first description of ptosis appearing in downgaze only, all measurements were made without the use of the frontalis muscle so as to study the effect of the only levator muscle on
Wojno TH. Loss of Vertical Palpebral Fissure Height on Downgaze in Acquired Blepharoptosis. Arch Ophthalmol. 1996;114(6):774. doi:10.1001/archopht.1996.01100130766034
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