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.

The Effect of Intraoperative Exophthalmometric Values on Enophthalmos Correction in Inferior Orbital Wall Reconstruction

PURPOSE: To measure the enophthalmos corrective effect after inferior orbital wall reconstruction, we compared preoperative and intraoperative exophthalmometric values with postoperative exophthalmometric values. METHODS: From January 2014 to April 2016, 60 eyes of 60 patients who underwent surgery for inferior orbital wall fracture were included. In Group 1, the exophthalmometric value was measured before surgery, during the operation, and 6 months after surgery using the Naugle exophthalmometer. In Group 2, the value was measured before surgery and 6 months after surgery using the Hertel exophthalmometer. The thickness of implants was determined by preoperative exophthalmometric values and overcorrection of 0.5 mm was performed in Group 1 patients with relatively large fractures. RESULTS: The mean age of the patients was 32.4 years in Group 1 and 34.3 years in Group 2. The mean duration between injury and surgery was 4.2 weeks in Group 1 and 2.3 weeks in Group 2. There was no statistically significant difference between preoperative exophthalmometric values in Group 1 (−1.78 ± 0.31 mm) and Group 2 (−1.81 ± 0.26 mm), but postoperative exophthalmometric values between Group 1 (−0.25 ± 0.78 mm) and Group 2 (−0.53 ± 0.46 mm) were statistically different (p = 0.034). CONCLUSIONS: The exophthalmometric values and wall fracture size are important factors for determining implant thickness of inferior orbital wall reconstruction. Intraoperative measurement of exophthalmometric values should be considered in inferior orbital wall reconstruction for enophthalmos correction.

Exophthalmometric values of Korean using Hertel and Naugle exophthalmometers

PURPOSE: The purpose of this study was to propose the mean exophthalmometric values of Korean using both Hertel and Naugle exophthalmometers. METHODS: We measured 176 eyes in 88 (Male 45, Female 43) normal subjects without any orbital disease using both Hertel and Naugle exophthalmometers. RESULTS: The analysis of Hertel measurements showed a mean reading of 17.2+/-1.5 mm in the male group, and of 16.1+/-1.4 mm in the female group, respectively. And the analysis of Naugle measurements showed a mean reading of 19.5+/-1.1 mm in the male group, and of 18.3+/-1.3mm in the female group, respectively. There was no difference among different age groups in male and female groups, respectively. The exophthalmometric value of Naugle measurement was significantly higher than that of Hertel measurement in both male and female groups by 2.3 mm and 2.2 mm respectively (p<0.05). CONCLUSIONS: In Korean, the exophthalmometric value of Naugle instrument is larger than Hertel in both male and female. And there is significant difference between male and female, but no difference among different age groups. These data can be useful for mean exophthalmometric value of Korean.

New Zygometer Incorporating Exophthalmometer

The zygoma is essential key element determining midface contour and symmetry. The height and width of the zygoma are changed during midfacial surgery such as reduction of fractured zygoma, esthetic malar reduction and correction of congenital midfacial deformity. The exact preoperative and postoperative evaluation of the zygoma is very important step in midfacial surgery. The estimation of height and width of the zygoma usually depends on gross feature analysis or radiographic measurement. But the results are not accurate and subjective. Several device were used for measuring the height and width of the zygoma, but those are inconvenient and difficult to use. The fracture of the zygoma is frequently combined with blow out fracture resulting enophthalmos. The simultaneous measurement of accurate malar height and degree of enophthlmos is helpful. For this reason, we developed a new zygometer with the function of exophthalmometer. This device is convenient to use and easy for comparative measurement of malar height preoperatively and immediate postoperative period, and the degree of enothphalmos is measured simultaneously with this device. This new zygometer will be applied to many midfacial surgery and craniofacial study.

Comparison of Reproducibility between Exophthalmometer Readings Measured with Hertel and Naugle Exophthalmometer

Hertel and Naugle exophthalmometers were used to compare the variability and reproducibility, produced by various observers. Five examiners measured fifty two eyes of twenty-six normal subjects each by using two different exophthalmometers, respectively. The average coefficient of variation among five measurements was 5.6% in the right eye, 5.2% in the left eye and 2.1% in base line by Hertel exophthalmometer. The average coefficient of variation measured by Naugle exophthalmometer was 1.9% in both eyes and 0.8% in pupillary distance. In conclusion, Naugle exophthalmometer showed less variability and better reproducibility; it is more appropriate for comparative exophthalmetry.

A Comparison of Hertel Exophthalmometer Measurements Between Various Manufacturer`s Models

To detect differences among the measurements of the Hertel exophthalmometers at different bar sizes and with different anufacturer`s models, exophthalmometries were performed for 27 normal subjects and 24 patients with thyroid ophthalmopathy at the three different bar sizes and with the models of three different manufacturers. The measurements decreased with the decrease of the bar size and increased with the increase of the bar size in all situations. The measurements of three different manufacturer`s models at the same bar size were different from each other. Therefore, Hertel exophthalmometries should be performed at the same bar size and with the same manufacturer`s model to find the exact changes of exophthalmos between repetitious examinations.