Lid Flare Measurement with Lateral Midpupil Distances

Equitério, Bruna; Garcia, Denny M.; Cruz, Anna Bárbara de Souza; Rootman, Daniel B.; Goldberg, Robert A.; Salles-Sanz, Marco; Galindo, Alicia; Diniz, Stefania B.

doi:10.1080/02713683.2021.1878541

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…Although the lateral flare sign has been frequently described in previous studies, the most retracted part of the eyelid varies among individuals. The maximum retraction predominantly appears at 30° to 75° from the midline (12,13,31,32). Traditionally, quantitative analysis of TAO eyelids has been mainly performed according to the MRD and PF, which reflect the severity of eyelid retraction.…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers have attempted to quantitatively describe the eyelid contour on digital face images (11)(12)(13)(14)(15)(16)31,32,(37)(38)(39)(40)(41)(42). Cruz et al (37) measured the upper eyelid contour in ptosis and Graves disease and fitted the contours with second-degree polynomial functions.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies applied MPLD to analyze eyelid malposition, but the task was time-consuming since the intersections of radial lines and eyelids still needed to be marked manually (12)(13)(14)17,31). The Bezier line with manual adjustment has been applied to quantify the contour of the upper or lower eyelid in TAO eyes (16,32,39), but manual marks or adjustments increase the workload for clinicians. Unlike previous studies (12)(13)(14)(15)(16)(17)31,32,(37)(38)(39), the analysis system proposed in this paper was fully automatic and capable of providing important eyelid features for the clinic, including PF, MRD1, MRD2, and MPLD.…”

Section: Discussionmentioning

confidence: 99%

“…The Bezier line with manual adjustment has been applied to quantify the contour of the upper or lower eyelid in TAO eyes (16,32,39), but manual marks or adjustments increase the workload for clinicians. Unlike previous studies (12)(13)(14)(15)(16)(17)31,32,(37)(38)(39), the analysis system proposed in this paper was fully automatic and capable of providing important eyelid features for the clinic, including PF, MRD1, MRD2, and MPLD. When large volumes of facial images needed to be analyzed, this automatic system could measure eyelid parameters without human involvement, saving time and effort.…”

Section: Discussionmentioning

confidence: 99%

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Deep learning-based image analysis of eyelid morphology in thyroid-associated ophthalmopathy

Shao¹,

Huang²,

Gao³

et al. 2023

Quant Imaging Med Surg

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Background:We aimed to propose a deep learning-based approach to automatically measure eyelid morphology in patients with thyroid-associated ophthalmopathy (TAO).Methods: This prospective study consecutively included 74 eyes of patients with TAO and 74 eyes of healthy volunteers visiting the ophthalmology department in a tertiary A hospital. Patients diagnosed as TAO and healthy volunteers who were age-and gender-matched met the eligibility criteria for recruitment.Facial images were taken under the same light conditions. Comprehensive eyelid morphological parameters, such as palpebral fissure (PF) length, margin reflex distance (MRD), eyelid retraction distance, eyelid length, scleral area, and mid-pupil lid distance (MPLD), were automatically calculated using our deep learningbased analysis system. MRD1 and 2 were manually measured. Bland-Altman plots and intraclass correlation coefficients (ICCs) were performed to assess the agreement between automatic and manual measurements of MRDs. The asymmetry of the eyelid contour was analyzed using the temporal: nasal ratio of the MPLD. All eyelid features were compared between TAO eyes and control eyes using the independent samples t-test.Results: A strong agreement between automatic and manual measurement was indicated. Biases of MRDs in TAO eyes and control eyes ranged from −0.01 mm [95% limits of agreement (LoA): −0.64 to 0.63 mm] to 0.09 mm (LoA: −0.46 to 0.63 mm). ICCs ranged from 0.932 to 0.980 (P<0.001). Eyelid features were significantly different in TAO eyes and control eyes, including MRD1 (4.82±1.59 vs.2.99±0.81 mm; P<0.001), MRD2 (5.89±1.16 vs. 5.47±0.73 mm; P=0.009), upper eyelid length (UEL) (27.73±4.49 vs. 25.42±4.35 mm; P=0.002), lower eyelid length (LEL) (31.51±4.59 vs. 26.34±4.72 mm; P<0.001), and total scleral area (SA TOTAL ) (96.14±34.38 vs. 56.91±14.97 mm 2 ; P<0.001). The MPLDs at all angles showed significant differences in the 2 groups of eyes (P=0.008 at temporal 180°; P<0.001 at other angles). The greatest temporal-nasal asymmetry appeared at 75° apart from the midline in TAO eyes.Conclusions: Our proposed system allowed automatic, comprehensive, and objective measurement of eyelid morphology by only using facial images, which has potential application prospects in TAO. Future work with a large sample of patients that contains different TAO subsets is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Deep learning-based image analysis of eyelid morphology in thyroid-associated ophthalmopathy

Shao¹,

Huang²,

Gao³

et al. 2023

Quant Imaging Med Surg

View full text Add to dashboard Cite

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“…As it has been already shown this single measurement is highly sensitive and specific for the diagnosis of flare. 7…”

Section: Methodsmentioning

confidence: 99%

Upper Eyelid Contour Changes After Orbital Decompression in Graves Orbitopathy

Cruz

Equitério

Diniz

et al. 2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To evaluate the effect of orbital decompression on the upper eyelid contour. Methods: A paired cross-sectional analysis of the upper eyelid contour was performed for 103 eyes of 66 patients who underwent orbital decompression. A control group of 26 normal subjects was also included. The eyelid contour of all participants were measured with Bézier lines adjusted to the eyelid contour and 9 midpupil eyelid margin (MPD) distances from a horizontal line bisecting the pupil. One central, corresponding to the margin reflex distance (MRD 1), and 8 equally distributed medially and laterally at 20% of the interval between the lines. Patients were classified as with flare if the height of the most lateral MPD relative to the MRD 1 was above the upper limit of the controls. Results: Preoperatively 63 of the 103 contours were classified as flare + (F+). After decompression MRD1 showed a mean decrease of 0.4 mm and the location of the contour shifted 0.8 mm medially. These changes were not correlated with proptosis reduction. Orbital decompression decreased the lateral curvature of the contours especially for the F+ lids. In 40% of the F+ eyelids the flare sign disappeared after decompression. Conclusions: Orbital decompression affects the lateral eyelid contour and diminishes the amount of lateral eyelid retraction surgery necessary to correct the flare sign. In 40% of the patients, the eyelid contour is normalized with proptosis reduction only.

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