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Aubrey Gilbert, Michael Yoon; The effect of eyelid manipulation on exophthalmometry values. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5346.
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Exophthalmometry is the standard for measuring the position of the globe in the orbit. Previous studies assessing normal values include patients without ophthalmic or orbital disease. When examining patients with abnormalities such as blepharoptosis, practitioners either have patients maximally open their eyelids, or will manually elevate the eyelid. The effect of these two maneuvers on exophthalmometry values is unknown. This study evaluates exophthalmometry in normal participants in primary gaze, maximal eyelid opening, and manual eyelid opening.
Healthy volunteers were recruited to participate. Participants were seated with their head in a neutral position and gaze into the distance. Age and sex were recorded. In addition, margin reflex distance (MRD-1) was measured in standard fashion. Exophthalmometry measurements (using a Marco prism exophthalmometer) were obtained in three positions: primary gaze, maximal effort eyelid opening, and manual eyelid opening by the examiner sufficient to reveal superior scleral show. No force was applied to the globe.
Thirty volunteers were included. There were 14 men and 16 women aged 27 to 41 (mean 31). Average MRD-1 was 4. In primary gaze, the average exophthalmometry measurement was 17.4 mm. With both maximal eyelid opening and manual opening, the average was 17.3 mm. No significant difference in exophthalmometry measurement was found among the eyelid positions (primary gaze vs. maximal effort: p=0.29; primary gaze vs. manual opening: p=0.20; maximal effort vs. manual opening: p=0.33 (Student t-test)).
In normal participants exophthalmometry measurements do not vary with eyelid manipulation. In patients with eyelid or orbital conditions requiring manual eyelid elevation or maximal effort to perform exophthalmometry measurements, the values are likely unaffected by these maneuvers.
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