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Tal Joshua Rubinstein, Bryan R Costin, Maria M Choudhary, Adam Weber, Julian D Perry; Effect of posterior approach blepharoptosis repair on eyebrow position and predictability of preoperative phenylephrine testing. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3104.
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Through poorly understood mechanisms, blepharoptosis often results in compensatory eyebrow elevation. Conversely, blepharoptosis repair may diminish this compensation leading to lowering of the eyebrows. We sought to understand the effect of blepharoptosis repair on eyebrow height and contour, and to determine if preoperative topical phenylephrine can predict postoperative eyebrow height.
This was a retrospective chart review of a consecutive group of patients undergoing unilateral conjunctival-Mullerectomy with or without tarsectomy (CM+-T) blepharoptosis repair by one surgeon (JDP) at the Cole Eye Institute between July 2012 and October 2013. Exclusion criteria included concurrent or prior eyelid and eyebrow surgery, lack of appropriate photographs, and known history of systemic diseases affecting the eyelid. Preoperative, post-phenylephrine, and postoperative photographs were analyzed for each patient. Pixel measurements were made using ImageJ software (NIH, USA). Measurements were bilateral and included MRD1, lateral brow height (LBH), central brow height (CBH), and medial brow height (MBH). We standardized the measurements to an arbitrary horizontal corneal diameter of 11 mm. Paired student t-test and Pearson product correlation were used for analysis.
Sixty-seven patients were identified and 58 were excluded. Of the remaining 9 patients, 8 patients were female. Average age was 58 years (range, 32 -85). Average ipsilateral preoperative MRD1 was 1.56 mm and average postoperative MRD1 was 3.13 mm (p = 0.0006). Ipsilateral LBH decreased by 1.11 mm (p = 0.019); ipsilateral CBH and MBH showed no significant change postoperatively. Contralateral LBH was increased by 0.92 mm (p = 0.0283); contralateral CBH and MBH showed no significant change postoperatively. Pearson product coefficients indicated high correlations for all brow height measurements between preoperative with phenylepherine photographs and postoperative photographs (r>0.90).
Unilateral blepharoptosis repair may alter bilateral lateral eyebrow position. It lowers ipsilateral lateral eyebrow position and elevates contralateral lateral eyebrow position, possibly by altering and/or inducing compensatory mechanisms. Preoperative topical 10% phenylepherine testing highly predicts postoperative brow height. These findings may guide operative planning and patient counseling.
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