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

Abstract

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.

Case Report: Treatment of Myasthenic Ptosis with Topical Ocular Oxymetazoline

“…Elevation of the ptotic eye manually or by using a pharmaceutical agent such as phenylephrine often results in a clinically insignificant depression of the contralateral eye lid. 14 This occurs because, with digital elevation or with a pharmaceutical agent, innervation to the ptotic levator palpebrae superioris is decreased. By Hering's law of equal innervation, the contralateral levator muscle also receives less innervation and consequently relaxes, resulting in a slight ptosis.…”

“…Phenylephrine 10% has been used as a surgical test to evaluate the surgical effect of the contralateral eye. Elevation of the ptotic eye manually or by using a pharmaceutical agent such as phenylephrine often results in a clinically insignificant depression of the contralateral eye lid 14 . This occurs because, with digital elevation or with a pharmaceutical agent, innervation to the ptotic levator palpebrae superioris is decreased.…”