Hering's Law, the Levators, and Their Relationship in Disease States

Gay, Andrew J.; Salmon, M; Windsor, Callan

doi:10.1001/archopht.1967.00980020159002

Cited by 83 publications

(30 citation statements)

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“…Our study confirmed previous reports of the occurrence or worsening of lid retraction after use of BTA in the opposite eye attributed to the effect of Hering's law on the eyelid retractor muscles. 18 In our study, some patients did in fact present lid retraction, or worsening of lid retraction, in the contralateral eye, but the effect did not extend beyond 2 weeks after treatment (Table 2). Thus, the effect in the contralateral eye lasted much less than the effect of Botox in the injected eye, suggesting that adaptative mechanisms in the neuronal inputs to the non-injected eyelid may occur.…”

Section: Discussionmentioning

confidence: 46%

Comparative study of Botox® injection treatment for upper eyelid retraction with 6-month follow-up in patients with thyroid eye disease in the congestive or fibrotic stage

Costa

Saraiva

Pereira

et al. 2008

Eye

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Aim To compare morphometric data of the eyelid fissure and the levator muscle function (LF) before and up to 6 months after transcutaneous injection with five units of Botox s in patients with upper lid retraction (ULR) from congestive or fibrotic thyroid eye disease (TED). Methods Twenty-four patients with ULR from TED were submitted to transcutaneous injection of 5 units (0.1 ml) of Botox in one eye only. Patients were divided into two groups: 12 with congestive-stage TED (CG), and 12 with fibrotic-stage TED (FG). Bilateral lid fissure measurements using digital imaging and computer-aided analysis were taken at baseline and at regular intervals 2 weeks, 1 month, 3 months and 6 months after unilateral Botox injection. Mean values taken at different follow-up points were compared for the two groups. Results Most patients experienced marked improvement in ULR, with a mean reduction of 3.81 mm in FG and 3.05 mm in CG. The upper eyelid margin reflex distance, fissure height and total area of exposed interpalpebral fissure were significantly smaller during 1 month in CG and during 3 months in FG. Reduction in LF and in the difference between lateral and medial lid fissure measurements was observed in both groups. The treatment lasted significantly longer in FG than in CG.Conclusions A single 5-unit Botox injection improved ULR, reduced LF and produced an adequate lid contour in patients with congestive or fibrotic TED. The effect lasts longer in patients with fibrotic orbitopathy than in patients with congestive orbitopathy.

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Section: Discussionmentioning

confidence: 46%

Comparative study of Botox® injection treatment for upper eyelid retraction with 6-month follow-up in patients with thyroid eye disease in the congestive or fibrotic stage

Costa

Saraiva

Pereira

et al. 2008

Eye

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“…Gay et al (4) suggested that the phenomenon may be explained by Hering's law, which states that the muscles responsible for eye movement in each eye are innervated equally as observed in the lateral and medial rectus muscles during horizontal version. Hering's law posits that the same amount of stimulus is transmitted to each of the two muscles in a pair.…”

Section: Introductionmentioning

confidence: 99%

“…Likewise, Averbuch-Heller et al (3) observed the descent of the contralateral eyelid following the elevation of the ptotic eyelid in patients with neuromuscular blepharoptosis. To explain this phenomenon, Gay et al (4) cited Hering's law, which states that the muscles responsible for eye movement in each eye are innervated equally (as observed for the lateral and medial rectus muscles during horizontal version) and the same amount of stimulus is transmitted to each of the two muscles in a pair. However, in his original study, Hering did not specify whether the law of motor correspondence applies to the LPSM (Hering apud Gay et al) (4) .…”

mentioning

confidence: 99%

“…To explain this phenomenon, Gay et al (4) cited Hering's law, which states that the muscles responsible for eye movement in each eye are innervated equally (as observed for the lateral and medial rectus muscles during horizontal version) and the same amount of stimulus is transmitted to each of the two muscles in a pair. However, in his original study, Hering did not specify whether the law of motor correspondence applies to the LPSM (Hering apud Gay et al) (4) . Erb et al (2) observed no significant difference between patients testing positive and negative for Hering's test prior to surgery.…”

mentioning

confidence: 99%

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Palpebral position interdependence in blepharoptosis: comparison of the effect of instillation of 10% phenylephrine drop and digital lifting

Pereira¹,

Matayoshi²

2014

Arquivos Brasileiros De Oftalmologia

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Purpose: To quantify and compare the effects of instillation with 10% phenylephrine and digital lifting on the contralateral upper eyelid of patients with involutional bilateral blepharoptosis. Methods: The present prospective clinical study involved patients with involutional bilateral blepharoptosis who underwent two tests: 1) digital lifting of the more ptotic eyelid and observation of the effect on the contralateral eyelid and 2) instillation of two drops of 10% phenylephrine in the more ptotic eye and observation of the effect on the contralateral eyelid. Patients were filmed before and 5, 10, and 15 min after instillation, and the resulting images were analyzed to obtain eyelid measurements. The results were tested using a linear mixed-effects model. Results: A total of 27 patients, ranging from 52 to 82 years of age (mean age 68.51 ± 8.21 years), 24 (88.88%) of whom were women, were included in the present study. In eyes that received instillation, the marginal distance reflex-1 (MDR1) values increased from baseline (1.21 ± 0.60 mm) until 10 min after instillation, then remained statistically unchanged until 15 min after instillation (2.42 ± 0.90 mm). Significant differences were observed in the contralateral eye of the group that underwent digital lifting (1.51 ± 0.53 mm -1.63 ± 0.56 mm) and in the contralateral eye of the group that underwent 10% phenylephrine instillation (1.38 ± 0.54 mm -1.63 ± 0.56 mm); p=0.02 and p<0.01, respectively. Conclusions: In all eyes, 10% phenylephrine elevated the upper eyelid, with improved eyelid height at 10 min after instillation. Significant differences were observed in the height of the contralateral eyelid when compared before and after each intervention in each group; however, this difference was very small and nearly undetectable by conventional clinical evaluation in the digital lifting group. However, the 10% phenylephrine eye-drop test resulted in substantial changes in MDR1 values in the treated and contralateral eyes, indicating clinical and statistical efficiency.

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“…É comum o uso do termo "pseudorretração" ou "retração" da PS contralateral induzida por ptose ou pela instilação de colírio de fenilefrina em alguns estudos [82][83][84]89,109,110 . É um termo que pode levar à interpretação errônea do fenômeno, pois são considerados casos de elevação da PS e não exatamente estrita retração (definida como DMR1 acima de 4,5 mm) 39 .…”

Section: Exemplos De Respostas Aos Testes Nos Três Gruposunclassified

Comparação do teste de fenilefrina a 10% com o teste do levantamento manual da pálpebra ptótica em pacientes portadores de ptose palpebral involucional

Pereira¹

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Hering's Law, the Levators, and Their Relationship in Disease States

Cited by 83 publications

References 0 publications

Comparative study of Botox® injection treatment for upper eyelid retraction with 6-month follow-up in patients with thyroid eye disease in the congestive or fibrotic stage

Comparative study of Botox® injection treatment for upper eyelid retraction with 6-month follow-up in patients with thyroid eye disease in the congestive or fibrotic stage

Palpebral position interdependence in blepharoptosis: comparison of the effect of instillation of 10% phenylephrine drop and digital lifting

Comparação do teste de fenilefrina a 10% com o teste do levantamento manual da pálpebra ptótica em pacientes portadores de ptose palpebral involucional

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