Clinical Feature of Unilateral Ptosis with Positive Result in Phenylephrine Test

PURPOSE: To investigate the clinical features and therapeutic effects of unilateral ptosis in patients who respond to the phenylephrine (PE) test. METHODS: Patients who presented with unilateral ptosis from January 2010 to December 2014 and underwent a PE test were included in the analysis. A 2.5% ophthalmic solution of phenylephrine hydrochloride was instilled at the superior conjunctival fornix in the ptotic eye. After 10 minutes of instillation, the patients' eyelid heights were evaluated. Underlying systemic diseases were examined based on previous medical history, a blood test, neurologic examination, and radiologic imaging findings. RESULTS: Twenty-six of 44 patients who underwent a PE test showed positive results. Fourteen (53.8%) patients with positive PE test had systemic disease, and 2 (11.2%) patients had systemic disease with negative PE test. In the positive PE test group, the associated systemic disease frequency was remarkably high (p = 0.004). Myasthenia gravis (MG) was found more frequently in the positive PE test group than in the negative PE test group (p = 0.031). After 6 months, the interpalpebral fissure height increased by 2.20 mm in the positive PE test group and 2.38 mm in the negative PE test group. Patients receiving medication treatment experienced an increase in interpalpebral fissure height of 2.00 mm in the positive PE test group and 2.50 mm in the negative PE test group. In patients undergoing observation alone, the interpalpebral fissure height increased by 1.50 mm in the positive PE test group and 0.80 mm in the negative PE test group. There was no significant difference in treatment methods (respectively, p = 0.147, p = 0.228 and p = 0.112). CONCLUSIONS: The PE test can be considered to help with differential diagnosis when examining patients with mild to moderate ptosis. If the PE test is positive, underlying comorbidity including MG should be considered.

Clinical Outcomes of Conjunctiva-Muller Muscle Resection and Factors Which Affect Success

PURPOSE: To investigate clinical outcomes and to analyze the factors of successful treatment of conjunctiva-Muller muscle resection (CMMR) in patients with mild to moderate ptosis. METHODS: The medical records of 22 patients (30 eyes) with upper lid ptosis were retrospectively reviewed. All patients underwent conjunctiva-Muller muscle resections, and four patients (seven eyes) underwent concurrent upper lid blepharoplasty. The mean follow-up period was 81.62 +/- 21 days. Pre- and post-operative MRD1, IPF and pupil to brow distance were measured using the Image J program. A preoperative phenylephrine test and a pathologic examination were performed to analyze the presence of Muller's muscle and the tear secreting glands from the CMMR specimens. RESULTS: The overall success rate of the procedure was 93%. Postoperatively, the MRD1 increased on average by 1.47 mm (p = 0.00) and increased by an average of 1.72 mm when the phenylephrine test response was greater than 2 mm and by 0.99 mm when the response less than 2 mm. The Muller muscle was observed in every specimen. CONCLUSIONS: Conjunctiva-Muller muscle resection is an effective and safe method for treating mild to moderate ptosis, for which the preoperative phenylephrine test result is the most important factor for surgical success.

Results of Conjunctiva-Muller Muscle Resection in Mild Eyelid Ptosis

PURPOSE: To assess surgical outcomes after adjusting the amount of resection of the conjunctiva and the Muller muscle according to 10% phenylephrine test results. METHODS: The charts of 32 patients (32 eyes) with mild upper eyelid ptosis were reviewed retrospectively. They all had conjunctiva-Muller muscle resections. A preoperative 10% phenylephrine test was performed to determine the resection amount of the Muller muscle and conjunctiva. An 8 mm resection was performed when phenylephrine raised the ptotic lid to the same level as that of the contralateral lid. A 7 mm resection was performed when the ptotic lid was raised to a level higher than that of the contralateral lid. A 9 mm resection was performed when the ptotic lid was raised to a level not quite to the level of the contralateral lid. RESULTS: Of the 32 patients, 28 were female and 4 were male. The mean age of the patients was 30.8+/-10.2 years. Patients were followed up for an average of 40.2+/-36.8 days, postoperatively. Postoperative upper lid positions were exactly symmetrical in 26 of the 32 patients. Five patients showed undercorrection, and 1 patient showed overcorrection. CONCLUSIONS: Excellent results were obtained by resecting the conjunctiva and Muller muscle according to the phenylephrine reaction of a ptotic eyelid.