Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis

PURPOSE: To analyze both the effects and the eyelid contour of Müller's muscle-conjunctival resection and levator aponeurosis advancement in patients with mild to moderate belpharoptosis. METHODS: We conducted a retrospective cross-sectional study including 20 eyes of 16 patients who underwent Müller's muscle-conjunctival resection and 25 eyes of 17 patients who underwent levator aponeurosis advancement from January 2012 to December 2015, where each patient was followed up for at least 6 months. Surgical success was defined as either a marginal reflex distance 1 (MRD₁) elevation greater than 2.5 mm postoperatively or a bilateral MRD₁ difference less than 0.5 mm. Both the conventional and 12 oblique mid-pupil lid distances were measured every 15 degrees using custom software developed in the MATLAB program (MathWorks, Natick, MA, USA). RESULTS: The average correction of Müller's muscle-conjunctival resection was 1.1 mm, while that of levator aponeurosis advancement was 0.9 mm. There was no significant difference in MRD₁, MRD₂, function of levator palpebrae muscle, or lid contour in the preoperative status between the Müller's muscle-conjunctival resection group and the levator aponeurosis advancement group. The surgical success rate was 85% in the Müller's muscle-conjunctival resection group and 84% in the levator aponeurosis advancement group, but this difference was not significant. The postoperative lid contour (superomedial side, 15°) was more effective in the Müller's muscle-conjunctival resection group (p < 0.05). CONCLUSIONS: Overall, both types of blepharoptosis surgery were effective at correcting mild to moderate blepharoptosis. The correction of mild to moderate blepharoptosis using Müller's muscle-conjunctival resection is an effective technique for elevating the eyelid and normalizing the eyelid contour.

The Lower Eyelid Movement by Inferior Oblique Muscle Action According to the Age

PURPOSE: There have been few studies on the dynamic analysis of lower eyelid movement. The inferior oblique muscle deep in the inferior orbit is well connected with the extraocular muscle by capsulopalpebral fascia and is involved in the lower eyelid movement. The purpose of this study was to determine the graphical equation of the lower eyelid contour and to quantify the dynamic movement of the lower eyelid at primary gaze and inferior oblique action gaze in normal eyes according to age, as such findings have never been reported before. METHODS: One hundred and forty subjects who had no previous eye or eyelid disease and surgery, aged from 5 to 68 years (35.75+/-30.59 years) were enrolled and divided into 7 age groups. We analyzed digital camera images to obtain the lower eyelid curvature and traveling distance of the lowest point of the lower eyelid accompanied by the action of the inferior oblique muscle. RESULTS: Graphical analysis presented the relationship of the cubic equation resembling the lower eyelid contour. The curvature of the lower eyelid at the gaze of inferior oblique muscles action became flatter than that of the primary position in all age groups. The lowest point of the lower eyelid moved significantly to the medial position and up from the primary gaze at the gaze of the inferior oblique muscles action in all age groups. There was no difference in traveling distance of the lower eyelid at each direction between sexes and age groups. CONCLUSIONS: The lower eyelid movements associated with the inferior oblique muscle are believed to be innate. We suggest that the digital image analysis of the lower eyelid contour will be useful to analyze the lower eyelid movements.