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Philip Ngai, Jeremiah Tao; Comparative Ocular Effects of Topical Epinephrine Versus Phenylephrine in Ptotic and Non-ptotic Subjects. Invest. Ophthalmol. Vis. Sci. 2016;57(12):677.
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© ARVO (1962-2015); The Authors (2016-present)
Injected 1% lidocaine with epinephrine 1:100,000 (LE100), commonly used in blepharoptosis surgery, may elevate the upper eyelid through sympathetic effects on Müller’s muscle (Trans Am Ophthalmol Soc. 1996;94:165-73) and can also induce pupil dilatation. Such stimulation of sympathetic pathways may affect intraoperative assessment during ptosis surgery. Exposure of the ocular surface to LE100 can occur during ptosis repair, though the effects have not been described. Herein we compare the effect of topical LE100 and phenylephrine on upper eyelid position and pupil size.
Upper eyelid margin reflex distance (MRD-1) and pupil diameter were measured at baseline and 5 minutes after application of topical LE100 in one eye of 14 non-ptotic and 10 ptotic patients. Measurements were obtained by digital photography with each subject’s head and eyes in primary position. After >48 hours each eye was exposed to topical phenylephrine 2.5% and the same measurements were obtained.
Topical LE100 did not produce an increase in mean MRD-1 (p>0.05). Conversely, 19/24 eyes (13 non-ptotic, 6 ptotic) exhibited a significant increase (p<0.01) in MRD-1 (mean 0.59 mm) after application of phenylephrine. Change in MRD-1 was significantly greater (p<0.01) after exposure to phenylephrine than to LE100. 5/24 eyes (1 non-ptotic, 4 ptotic) did not exhibit an increase in MRD-1 in response to phenylephrine; these eyelids also did not elevate in response to LE100. Average pupil size increased 0.24 mm (p=0.013) after exposure to phenylephrine, and 0.27 mm (p<0.01) after instillation of LE100. The effect on pupil diameter was statistically similar between the two solutions (p>0.05).
Topical LE100 and topical phenylephrine had similar effects on pupil size, but not on MRD-1. The measurable response of the iris dilator muscle was not coupled with a statistically significant response of Müller’s muscle. These data may have implications on intraoperative measurements recorded during ptosis surgery. Importantly, a surgeon should not presume there is elevation of the upper eyelid when pupil dilatation is noted after eye exposure to LE100.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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