Investigation of morphometric measurement of the eyelid and ocular axial position in Mongolian adults / Шинэ санаа Шинэ нээлт

Background@#The shapes of the eye and upper eyelid are distinctive facial landmarks. The palpebral fissure is composed of the free edges of upper and lower eyelids the lateral and medial canthus. Many researchers confirmed that the morphometric characteristics of the palpebral fissure, canthal distance and exophthalmometirc value (EV) vary according to race, ethnicity, age and sex and normative values which may serve as a reference in the index population. Knowledge of normal dimensions, the existence of asymmetry of the palpebral fissure is of value in several clinical specialties including ophthalmology, plastic and reconstructive surgery and traumatology, where it plays a part in the patient evaluation, management and outcomes.@*Methods@#This cross-sectional study was conducted in the Ophthalmological Department, Third State Central Hospital between January 2022 and August 2022. We included participants who are above 18 years, no history of congenital or traumatic craniofacial deformities, any orbital fractures, tumors and surgeries. All measured values that represent eyelid shape and EV were calculated by mean and standard deviation for statistical analysis.@*Results@#A total of 103 participants aged 19-86 were included in the study, of which 44 (42.7%) were male and 59 (57.3%) were female. The distance between the lateral and medial canthus ranged from 20 to 35 mm, and the mean of the right and left side was 28.30+3.23 mm and 28.05+2.99 mm, respectively (p=0.561). The palpebral fissure height ranged from 5 to 13 mm, and the mean of the right and left side was 8.85+1.65 mm and 8.80+1.65 mm, respectively (p=0.816). The mean distance between the lateral canthi were 90.39+5.57 (range: 80-105 mm), whereas the mean distance between the medial canthi were 63.75+4.25 (range: 53-73 mm). The orbital height varied between 27-43 mm (33.73+3.72) and 26-44 mm (33.78+3.73) on the right and left sides, while the orbital width varied between 26-47 mm (36.75+4.53) and 27-45 mm (36.72+4.42) on the right and left sides, respectively. When measuring the exophthalmometric value (EV), the axial position of the eyeball, with the Hertel’s exophthalmometer, it ranged from 8 to 20 mm on both sides (mean value 13.68+3.01 and 13.71+3.00 on the right and left sides, respectively), and there was no statistically significant difference in symmetry (p=0.94).@*Conclusion@#The results are determined different from the findings of Chinese, Korean, Afro-American and Caucasian population based studies. Thus further evaluation is required to represent the normative value of Mongolian index population, that is highly beneficial for clinical assessment, diagnosis and management.

Morphometric analysis of the palpebral fissure and canthal distance in Serbian young adults / Análisis morfométrico de la fisura palpebral y la distancia cantal en adultos jóvenes serbios

SUMMARY: Frontaly and anteriorly the orbit is closed by a skin-muscular closure of eyelids. The eyelids limit the palpebral fissure, which is subject to geographical, racial, and age variations. As a part of the face, eyelids and palpebral fissure play a very important role in the attractiveness of the individual, but al so in the diagnosis of certain local and systemic pathological processes. The aim of the study was to perform a morphometric analysis of the palpebral fissure in a young population without pathological conditions and syndromes. The study was conducted on 90 subjects (45 male and 45 female) aged 19.28±0.69 years. Subjects were photographed with a Nikon D3400 camera, and the morphometric parameters were measured with the ImageJ 1.48v software. Statistical analysis of the data was performed in Windows Excel. The measurements in the study were the distance between the mid-points of both pupils, distance between both external canthi, distance between both internal canthi, palpebral fissure width and palpebral fissure height at three points. The average height of the palpebral fissure to the right is 9.35±1.55 mm and to the left is 9.41±1.56 mm. The average width of the palpebral fissure on the right is 27.05±1.71 mm and on the left is 27.18±1.68 mm. It was found that there was some difference in the measured parameters, however, this difference was not statistically significant.

RESUMEN: El músculo orbicular de los ojos se encuentra en la cara, delante de la órbita y debajo de la piel. Los párpados limitan la fisura palpebral, la abertura natural, sujeta a variaciones geográficas, raciales y de edad. Los párpados y la fisura palpebral juegan un papel importante en la estética de las personas, pero también en el diagnóstico de ciertos procesos patológicos locales y sistémicos. El objetivo del estudio fue realizar un análisis morfométrico de la fisura palpebral en una población joven sin enfermedades o condiciones patológicas. El estudio se realizó en 90 sujetos (45 hombres y 45 mujeres) de 19,28 ± 0,69 años. Los sujetos fueron fotografiados con una cámara Nikon D3400, y los parámetros morfométricos se midieron con el software ImageJ 1.48v. El análisis estadístico de los datos se realizó en Windows Excel. Se midieron la distancia entre los puntos medios de ambas pupilas, la distancia entre ambos cantos laterales, la distancia entre ambos cantos mediales, el ancho de la fisura palpebral y la altura de la fisura palpebral en tres puntos. La altura promedio de la fisura palpebral a la derecha fue 9,35 ± 1,55 mm y a la izquierda fue 9,41 ± 1,56 mm. El ancho promedio de la fisura palpebral a la derecha era 27,05 ± 1,71 mm y a la izquierda era 27,18 ± 1,68 mm. Se determinó una diferencia leve en los parámetros medidos, sin embargo, esta diferencia no fue estadísticamente significativa.

A quantitative approach to shortening the levator palpebrae superioris to correct congenital ptosis in children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To develop a feasible method to correct congenital ptosis in children.<p>METHODS: Sixty-four patients(102 eyelids)were divided into three groups based on the degree of ptosis: mild(<2 mm); moderate(3-4 mm)and severe(>4 mm). All patients underwent the same levator resection surgery in which the suspensory system of the LPS is retained. After capturing a standard photograph of primary position, the height of the superior palpebral margin was measured preoperatively by using Image J software to calculate its ideal height required during surgery. Postoperative outcome measures included upper eyelid margin height, degree of scleral exposure and exposure keratitis. The patients were followed-up at 1wk, 1mo and 6mo postoperatively.<p>RESULTS: In the early postoperative period, except two cases with overcorrection, the positions of the eyelid upper margins were normal in all cases in the mild and moderate groups. Six months postoperatively, the eye with overcorrection in the moderate group showed improvement, while the eye in the mild group did not. Seven eyes in the severe group exhibited residual ptosis to varying degrees. The eyelids exhibited appropriate closing functionality; exposure keratitis was absent.<p>CONCLUSION:Using this preoperative quantification technique to guide surgery not only provided a gauge for LPS shortening under general anesthesia, but also increased the success rate of surgery.

Modified Schirmer tear test and rebound tonometry in blue-fronted Amazon parrot (Amazona aestiva) / Teste lacrimal de Schirmer modificado e tonometria de rebote em papagaio-verdadeiro (Amazona aestiva)

The aim of this study was to describe the modified Schirmer tear test (mSTT), intraocular pressure (IOP) by rebound tonometry and palpebral fissure length (PFL) in blue-fronted Amazon parrots (Amazona aestiva). Thirty-five healthy adult animals from a conservation breeding center in Brazil were used in this study. Modified Schirmer tear test, rebound tonometry and PFL measurements were performed in both eyes, with birds under physical restraint. Mean mSTT was 6.2±0.1mm/min and mean IOP was 6.4±0.1mmHg, while PFL was 10.1±0.1mm. A moderate correlation was seen between mSTT and PFL for OD (ρ=0.14) and OS (ρ=0.20). The results provide ophthalmic tests reference values for A. aestiva.(AU)

O objetivo deste estudo foi descrever o teste lacrimal de Schirmer modificado (TLSm), a pressão intraocular (PIO) pela tonometria de rebote e o comprimento da fissura palpebral (FP) do papagaio-verdadeiro (Amazona aestiva). Foram avaliados 35 papagaios adultos e saudáveis, provenientes de um Criadouro Conservacionista do Brasil. Após avaliação clínica e laboratorial, as aves foram fisicamente contidas para aferição, em ambos os olhos, do TLSm, da PIO pela tonometria de rebote e do comprimento da FP utilizando-se um paquímetro digital. Valor médio do TLSm foi 6.2±0.1mm/min e da PIO foi 6.4±0.1 mmHg, enquanto a aferição da FP foi 10.1±0.1mm. Uma correlação moderada foi observada entre TLSm e a FP para olho direito (OD) (ρ=0.14) e olho esquerdo (OE) (ρ=0.20). Os resultados podem servir como valores de referência para testes oftálmicos para A. aestiva.(AU)

Relationship between Palpebral Fissure Height and Corneal Astigmatism of Epiblepharon

PURPOSE: To study the effect of plapebral fissure height on astigmatism in epiblepharon patients. METHODS: The study consisted of 68 eyes of 34 patients who were diagnosed with epiblepharon and 88 eyes of 44 patients who had normal eyelids from September 2012 to July 2013. Data on palpebral fissure height and refractive errors were compared between the epiblepharon group and the control group. Epiblepharon patients were further divided into two subgroups depending on the degree of preoperative corneal erosion in order to study the effects of corneal erosion on corneal astigmatism. RESULTS: The mean age was 5.6 ± 2.2 years in the epiblepharon group and 6.1 ± 1.5 years in the control group (p = 0.339). The mean astigmatism was 2.28 ± 1.54 D in the epiblepharon group and 0.91 ± 1.07 D in the control group. The epiblepharon group showed higher astigmatism than the control group (p < 0.001). The mean palepebral fissure height was 6.70 ± 1.19 mm in the epiblepharon group and 7.63 ± 1.06 mm in the control group. The epiblepharon group exhibited smaller palpebral fissure height than the control group (p < 0.001). In the palpebral fissure height subgroups of the epiblepharon group, the <7.0 mm group showed higher astigmatism than the ≥7.0 mm group (p = 0.026). Higher astigmatism was associated with smaller palpebral fissure height (p = 0.022). CONCLUSIONS: Patients with epiblepharon had significantly higher corneal astigmatism, and higher astigmatism was associated with smaller palpebral fissure height.

The effect of anterior transposition of the inferior oblique muscle on eyelid configuration and function.

Purpose: To evaluate the alteration of lower lid configuration and function with anterior transposition surgery of the inferior oblique (IO) muscle. Patients and Methods: A prospective clinical trial was conducted on a consecutive series of patients underwent anterior transposition of the IO as a sole operation. All patients received a thorough ophthalmic examination 1 day before and 3 months after surgery. Output parameters were consisted of palpebral fissure, margin reflex distance 1–2, lower lid function, hertel value, and lower lid crease. The differences of the collected data were calculated for statistical significance by using the Wilcoxon test. Results: A total of 19 eyes of 16 consecutive patients were included. The median preoperative grade of IO overaction was 3.5 (ranging from 3 to 4), which decreased to 0 (ranging from 0 to 2) postoperatively (P < 0.05). No significant change was observed in all parameters 3 months postoperatively (P > 0.05). Conclusion: In this study, no significant effect on lower lid configuration and function was observed following IO anterior transposition in which the disinserted muscle was placed posterior to inferior rectus insertion.

Widening of Palpebral Fissure Due to Lateral Rectus Muscle Recession

PURPOSE: To evaluate the incidence and course of widening of palpebral fissure after unilateral lateral rectus muscle recession. METHODS: The palpebral fissure width (PFW) was measured in 20 patients with intermittent exotropia before unilateral rectus muscle recession and 1 week, 1 month and 6 months after the surgery. RESULTS: The amount of recession was from 7.5 to 9.0 (mean 8.37 +/- 0.51) mm. More than 0.6 mm of change in PFW after surgery was defined as the significant change. The significant change was observed in 10 patients (50%) after 1 week, 7 patients (35%) after 1 month and 7 patients (35%) after 6 months after the surgery. The amount of recession was significantly greater in the group with significant change (8.60 +/- 0.39 mm) than the group without significant change (8.15 +/- 0.53 mm) (p < 0.05). CONCLUSIONS: Thirty five percent of the patients showed palpebral fissure widening lasts at least 6 months after unilateral lateral rectus muscle recession. We think it is necessary to notice patients about the possible change in palpebral fissure width before strabismus surgery. And we believe that more cosmetically satisfactory outcome would be resulted if surgeons consider eyelid condition when they are planning strabismus surgery.

Medida da fissura palpebral e da borda vermelha do lábio superior de recém-nascidos com idade gestacional de 25 a 43 semanas / Measurement of the palpebral fissure and the vermilion border of the upper lip in newborns with gestational ages of 25 to 43 weeks

Objective: To prepare percentile curves for measurements of palpebral fissure and the greatest width of the vermilion border of the upper lip in newborns at a public maternity ward in the City of São Paulo. Methods: A descriptive cross-sectional study was carried out from August 2006 to January 2008. In the first 24 to 72 hours of life, the palpebral fissure and the greatest width of the vermilion border of the upper lip were measured in 1,964 newborns with gestational ages from 25 to 43 weeks. Percentile curves corresponding to these measurements were prepared according to gestational age. Results: The average measurement of palpebral fissure was 1.98 cm, ranging from 0.80 to 3.00 cm, standard deviation ± 0.24 cm. The average measurement of the width of the vermilion border of the upper lip was 0.51 cm, ranging from 0.20 to 0.90 cm, standard deviation ± 0.11 cm. These measurements allowed designing the percentile curves (10th, 50th, and 90th) relative to gestational age. Conclusions: Measurement curves of palpebral fissure and of the greatest width of the vermilion border of the upper lip may be useful to evaluate the presence of facial dimorphism in newborns.

Objetivo: Elaborar curvas de percentis das medidas da fissura palpebral e da maior largura da borda vermelha do lábio superior de recém-nascidos em maternidade pública da cidade de São Paulo. Métodos: Estudo descritivo transversal realizado de Agosto de 2006 a Janeiro de 2008. Nas primeiras 24 a 72 horas de vida, foram feitas medidas da fissura palpebral e da maior largura da borda vermelhado lábio superior de 1.964 recém-nascidos com idade gestacional de 25 a 43 semanas. Curvas de percentil correspondentes a essas medidas foram elaboradas de acordo com a idade gestacional.Resultados: A média da medida da fenda palpebral foi de 1,98 cm, variando de 0,80 a 3,00 cm, com desvio padrão de ± 0,24 cm. A maior largura da borda vermelha do lábio superior teve uma medida média de 0,51 cm, variando de 0,20 a 0,90 cm, com desvio padrão de ± 0,11 cm. Essas medidas permitiram a elaboração de curvas de percentil (10, 50 e 90) em relação à idade gestacional. Conclusões: As curvas elaboradas das medidas da fissura palpebral e da maior largura da borda vermelha do lábio superior podem ser úteis na avaliação da presença de dismorfias faciais de recém-nascidos.

Phenotypic and Cytogenetic Delineation of Six Korean Children with Kabuki Syndrome

PURPOSE: Kabuki syndrome is a multiple congenital malformation syndrome with mental retardation. It was named after its characteristic appearance, a face resembling that of an actor in a Kabuki play. To date, six Korean cases of Kabuki syndrome have ever been reported. Here, we present the phenotypic and genetic characteristics of six patients with Kabuki syndrome. MATERIALS AND METHODS: Between 2003 and 2009, six Korean girls have been diagnosed and followed up as Kabuki syndrome at Center for Genetic Diseases of Ajou University Hospital. Their clinical and laboratory data were collected and analyzed by the retrospective review of medical records. RESULTS: All six patients showed the characteristic facial dysmorphism and developmental delay. Persistent fingertip pads were also found in all patients. Most patients showed postnatal growth retardation (83.3%) and hypotonia (83.3%). Opthalmologic problems were common, particularly for strabismus (83.3%). Congenital heart defects were present in three patients (50%). Skeletal abnormalities including 5th finger shortening (83.3%), clinodactyly (50%), joint hypermobility (50%) and hip dislocation (16.7%) were also observed. There was no patient who had positive family history for Kabuki syndrome. Cytogenetic and molecular cytogenetic analyses including karyotyping and array CGH could not reveal any underlying genetic cause of Kabuki syndrome. CONCLUSION: Korean patients with Kabuki syndrome showed a broad spectrum of clinical features affecting multiple organ systems. Although clinical manifestations of Kabuki syndrome have been well established, our results failed to detect recurrent chromosome aberrations which could cause Kabuki syndrome. Its natural history and genetic background remains to be further studied for providing appropriate management and genetic counseling.

The Relationship between the Iris Diameter, Palpebral Fissure Width and Intercanthal Distance for Beautiful Eye

Double-fold blepharoplasty is one of the most common cosmetic procedures performed on Northeast asians. Generally, the majority of People regards that big eye is beautiful, which gives an attractive impression. If the obscure concept of beautiful eye is reconstructed and ideal palpebral fissure width is confirmed, It may be the useful marker of double-fold operation. The aims of this study were to find out which anthropometrical data of beautiful eye by analysis about the ratio of intercanthal distance(medial to lateral canthus), palpebral fissure width and iris diameter. A total of 112 women underwent the examination, their age ranged from 20 to 29 years. Anterior facial picture was taken by digital camera(7.1 megafixels, Cannon PowerShot G6(R), Japan) without strove light to prevent the blinking phenomenon. Among 112, 27 women were selected as beautiful eye group, and 27 women were selected as unattractive eye. The captured images were analyzed about the ratio of intercanthal distance, palpebral fissure width and iris diameter by using the computer measurement tool(Adobe photoshop 6.0, USA). We observed that the ideal ratio of intercanthal distance, palpebral fissure width and iris diameter is 0.94 : 2.23 : 1.00. The ratio of intercanthal distance and iris diameter between the attractive eye group and unattractive eye group was significantly different. Also the ratio of palpebral fissure width and diameter of iris between the attractive eye group and unattractive eye group was significantly different. The attractive eye group has more high score of palpebral fissure width/intercanthal distance. We concluded that the attractive eye is build by increasing ratio of intercanthal distance/iris diameter, palpebral fissure width/iris diameter. So the extensive operation is required not only the fold incision but also management levator palpebral muscle, debulking pretarsal tissue and plication of pretarsal skin flap.

The Frequency and Aspects of Ptosis in Korean Old Age

PURPOSE: To study the frequency and aspects of ptosis in Koreans aged 50 years or older. METHODS: In this study, 377 elderly people visiting retirement center were included. Margin-reflex distance 1 (MRD1) and palpebral fissure (PF) were evaluated with an attempt to eliminate eyebrow elevation. Levator function (LF) was measured with Berke's method. If the measured MRD1 was less than 2 mm, ptosis was diagnosed and its frequency, relation to sex, age, levator function and superior deep sulcus were investigated. RESULTS: There was a correlation between decreasing MRD1, PF and LF with increasing age. Ptosis was observed in 207 subjects (54.9%), and its frequency was augmented as age increased. Although it was not statistically significant, the levator function of those with ptosis (10.0+/-1.9 mm) was lower than those without ptosis (11.3+/-1.9 mm). Questionnaires were administered and 196 respondents (51%) said that their eyelid droop had become more pronounced over time. Among these respondents, 33 (16.1%) indicated that their droopy eyelid causes discomfort by blocking their vision. Their MRD1 was 1.2+/-1.0 mm, which was significantly lower than that of the other 163 respondents (1.8+/-1.1 mm, P<0.05). CONCLUSIONS: Koreans aged 50 years or older showed a very high frequency (54.9%) of ptosis and as age increased, the frequency of ptosis also increased. Surgical correction is recommended when the ptosis causes patient discomfort due to impaired vision.

The Frequency and Aspects of Ptosis in Korean Old Age

PURPOSE: To study the frequency and aspects of ptosis in Koreans aged 50 years or older. METHODS: In this study, 377 elderly people visiting retirement center were included. Margin-reflex distance 1 (MRD1) and palpebral fissure (PF) were evaluated with an attempt to eliminate eyebrow elevation. Levator function (LF) was measured with Berke's method. If the measured MRD1 was less than 2 mm, ptosis was diagnosed and its frequency, relation to sex, age, levator function and superior deep sulcus were investigated. RESULTS: There was a correlation between decreasing MRD1, PF and LF with increasing age. Ptosis was observed in 207 subjects (54.9%), and its frequency was augmented as age increased. Although it was not statistically significant, the levator function of those with ptosis (10.0+/-1.9 mm) was lower than those without ptosis (11.3+/-1.9 mm). Questionnaires were administered and 196 respondents (51%) said that their eyelid droop had become more pronounced over time. Among these respondents, 33 (16.1%) indicated that their droopy eyelid causes discomfort by blocking their vision. Their MRD1 was 1.2+/-1.0 mm, which was significantly lower than that of the other 163 respondents (1.8+/-1.1 mm, P<0.05). CONCLUSIONS: Koreans aged 50 years or older showed a very high frequency (54.9%) of ptosis and as age increased, the frequency of ptosis also increased. Surgical correction is recommended when the ptosis causes patient discomfort due to impaired vision.

A Case of Bell's Palsy with Narrowing of the Palpebral Fissure

Widened palpebral fissure has been regarded as one of the hallmarks of Bell's palsy. However, the palpebral fissure on the affected side may be narrower than that of the unaffected side. The narrowing of the palpebral fissure has been often thought as a sign caused by weakness of the levator palpebrae and Muller's muscles. However, weakness of the frontal muscle may cause drooping of the eyebrow, resulting in the narrowing of the palpebral fissure. We describe a patient of Bell's palsy with a narrowing of the palpebral fissure.

Anthropometric Analysis of Slant of Palpebral Fissure in Koreans

An upward slant of palpebral fissure is usually said and believed to be a hallmark of Mongolian race. The slant of palpebral fissure is very important in the evaluation and treatment of patients with congenital deformities. And these statistical values of slant of palpebral fissures are very helpful in case of traumatic or congenital lateral canthal deformities and upper face lift or forehead lift. The normal values of slant of palpebral fissures are variable according to races, sex and ages. Even if upward slant of palpebral fissure are one of characteristic features of Koreans, there are a few articles concerning them in Korea yet, unfortunately. So, we have inevitably utilized the Caucasian or Japanese statistical data. Authors measured the slant of palpebral fissure in Koreans, and statistically analyzed them in 996 individuals including 468 males and 528 females. The mean values of slant of palpebral fissure was 8.5+/-2.0degreein males and 8.8+/-2.5degreein females. The mean values of slant of palpebral fissure was greater in female than male. However, there was no statistical difference between males and females. The slant of palpebral fissure reached the peak level at childhood and teenagers in a great portion. After the peak level, the changing pattern of slant of palpebral fissure was decreasing gradually. In summary, we consider 8.65degreeas normal standard value of slant of palpebral fissure when performing lateral canthal surgery in Koreans.

Morphological Evaluation of Upper Eyelid in Korean

Facial appearance is influenced by the anatomic relationship of the eyebrow and eyelid. The morphology and normal anatomical value of upper eyelids are variable depending on race, sex and age, and have not been standardized yet in Korea. The authors statistically analysed normal anatomical variation of the upper eyelid morphology of 200 eyes of Koreans who had no surgery or trauma in the upper eyelid. One hundred men and one hundred women were included in this study. Physical examination of upper eyelid morphology included upper eyelid height, presence of upper eyelid crease and its level, height and width of palpebral fissure, height of tarsal plate, intercanthal distance, levator function, and presence of epicanthal fold with type. Average age was 21.09 in men and 23.03 in women, average heights of upper eyelid 15.04 mm and 16.05 mm, average heights of palpebral fissure 8.12 mm and 9.08 mm, average width of palpebral fissure 26.55 mm and 28.02 mm, average heights of tarsal plate 7.62 mm and 8.07 mm, and average intercanthal distances 36.82 mm and 35.90 mm. Increased values were noted in women compared to men, in upper eyelid height, height and width of palpebral fissure, and height of tarsal plate, especially levator fuction.But we couldn't find the statistical variation. Upper eyelid crease was noted in 29% in men, 54%in women.29 eyes in men and 24 eyes in women had epicanthal fold with epicanthus tarsalis being most prevalent morphologically. In our study, there was no meaningful difference of upper eyelid morphology depend on sex and we found that the favorate upper eyelid crease shape was the parallel crease type with narrow height in Koreans. These results may be beneficial in making a basic plan for the upper eyelid surgery such as blepharoplasty.

Comparison of Palpebral Fissure Height According to Horizontal

We compared palpebral fissure height according to horizontal fixation direction in normal subjects, strabismic patients[exotropia, esotropia, abducens nerve palsy], and patients with Duane's retraction syndrome. We respectively measured the palpebral fissure height of 39 normal subjects [78 eyes], 37 exotropia patients[74 eyes], 17 esotropia patients[34 eyes], 6 patients of abducens nerve palsy[6 eyes], and 8 patients with Duane's retraction syndrome[12 eye]. Measurements were obtained from standardized photographs in primary position, 30-degree adduction and abduction and maximum adduction and abduction of both eyes. The palpebral fissure height of normal subjects and exotropia patients was maximal in primary position and minimal in maximum adduction and abduction. On the other side, the palpebral fissure height of esotropia patients was maximal in 30 degree abduction. On the base of the height in primary position, the fissure height of normal subjects was 90%in maximum abduction and 89%in maximum adduction. But the fissure height of Duane's retraction syndrome was 103%in maximum abduction and 69%in maximum adduction. In normal group and exotropia, the fissure narrowed according to the degree of adduction and abduction, and in esotropia and abducens nerve palsy, the palpebral fissure of abducting eye was wider than that of primary position. In Duane's retraction syndrome the palpebral fissure of adducting eye markedly narrowed and the difference between the fissure height in maximum adduction and maximum abduction made diagnostic value in comparison to normal group.

Morphological Evaluation of Upper Eyelid in Korean Children

A prospective study was designed to evaluate upper eyelid morphology of 83 eyes of 83 children beneath the age of fifteen who had visited our hospital between May 1996 and April 1997. Forth three boys and forth girls were included in this study. Physical examination of upper eyelid morphology included upper eyelid height, presence of upper eyelid crease and its level, height and width of palpebral fissure, intercanthal distance, levator function, and presence of epicanthal fold with type. There were no gender-related statistical differences in this study. Average heights of upper eyelid was 11.87mm in boys and 11.68mm in girls, average heights of palpebral fissure 7.67mm and 8.23mm, average width of palpebral fissure 23.62mm and 23.77mm, average intercanthal distances 31.93mm and 31.75mm. To match the age, study group were devided into two as Group 1: 1-6 years old and Group 2: 7-15 years old. Average width of palpebral fissure was 22.31mm in group 1 and 26.39mm in group 2. Increased values were noticed in group 2 compared to group 1, upper eyelid height, height of palpebral fissure, intercanthal distance, especially width of palpebral fissure. Fifty-one eyes(61.4%) have epicanthal fold with epicanthus tarsalis being most prevalent morphologically. Thirty upper lid creases were detected there was meaningful differencd of upper eyelid morphology by age, and not by gender.

The Effect on the Dryness of Eye during VDT Work

The ocular symptoms of visual display terminal (VDT) syndrome are caused by asthenopia, electromagnetic waves, and eye fatigue. To find out what cause make the fatigue of eye during VDT work, we measured frequency of blinking and height of palpebral fissure at near, reading a book, and during VDT work. Tear film break-up time(BUT) was measured immediately after the VDT work and during reading a book. The frequency of blinking during VDT work and book reading decreased significantly comparing with the one at rest (p<0.01). The average frequency of blinking is 20.52 +/- 5.89/min at rest, 8.29 +/- 4.15/min at VDT work, and 10.31 +/- 5.48/min at reading. The BUT measured immediately after VDT work decreased much more than in the resting state (p<0.01). The average BUT was 11.52 +/- 3.41sec at rest and 6.18 +/- 2.65sec immediately after VDT work. The height of palpebral fissure during VDT work increased significantly comparing with the value at rest (p<0.01). The average height of palpebral fissure was 7.39 +/- 0.78mm at rest and 8.83 +/- 0.75mm during VDT work. This study reveals the fatigue of eye during VDT work was induced by the dryness of eye resulted from the increased evaporation due to the decrement in the frequency of blinking and the widening of palpebral fissure. To prevent the fatigue of eye caused by dryness during VDT work, it is important for VDT workers to intend to blink frequently, place VDT lower than eye level to reduce the height of palpebral fissure, humidify the room adequately, put artificial eye tear in eye frequently, and take a rest after 20 mimutes work at least.