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T. Nakra, G.J. Ben Simon, J.D. Mc Cann, R.A. Goldberg; Neuro–Ophthalmologic Implications of Ipsilateral Frontalis Muscle Recruitment in Anophthalmic Eyes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4217.
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© ARVO (1962-2015); The Authors (2016-present)
To describe a unique facial neuro–muscular phenomenon in anophthalmic patients.
This is a retrospective, non–comparative case series. The Electronic Medical Record of the Division of Orbito–Facial Plastic and Reconstructive Surgery at the Jules Stein Eye Institute was reviewed to identify patients who underwent enucleation or evisceration surgery from January 1999 through April 2003. Records with clinical post–operative photographs were collected for review. Patients with facial trauma were excluded. Only those photographs depicting a full frontal face view of the patient in orthotropic gaze were reviewed. The degree of frontalis muscle activity on the anophthalmic side was evaluated by grading the eyebrow position: marked ptosis, mild ptosis, symmetrical, mild elevation, or marked elevation.
44 patients were identified that met the inclusion criteria. 1 patient (2%) displayed marked eyebrow ptosis. 6 patients (14%) displayed mild eyebrow ptosis. 14 patients (32%) displayed symmetry of both eyebrows. 19 patients (43%) displayed mild eyebrow elevation. 4 patients (9%) displayed marked eyebrow elevation. (Note figure 1: example of ipsilateral eyebrow elevation in left–sided anophthalmia.)
Ipsilateral frontalis muscle recruitment is a novel finding present in the majority of anophthalmic patients reviewed in this study. This study demonstrates the presence of non–visual stimuli in frontalis muscle recruitment, challenging the currently accepted notion that only visual stimuli drive frontalis muscle recruitment beyond baseline. Afferent sensory signals in the anophthalmic orbit may potentiate frontalis recruitment, such as upper eyelid ptosis resulting in stretching of the levator palpebrae superioris.
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