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M. J. Trager, T. N. Hwang, L. S. Pereira, R. C. Kersten, W. J. Feuer, T. J. McCulley; Assessment of Levator Muscle Function in the Fellow Eye of Patients With Asymmetric Involutional Blepharoptosis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2302. doi: https://doi.org/.
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Traditionally, aponeurotic changes rather than levator muscle weakening is thought to lead to involutional blepharoptosis. Recently, a small decrease in levator muscle (LF) function proportional to the degree of blepharoptosis has been demonstrated in a cohort of patients with involutional blepharoptosis, suggesting that levator function may be an important factor in involutional blepharoptosis. This study further evaluates this relationship by assessing fellow eye levator function in patients with asymmetric blepharoptosis.
Margin reflex distance and LF was determined in 59 patients (mean age of 66.1, 24 males, 35 females) with asymmetric blepharoptosis of greater than 1 mm via retrospective chart review. Of those patients, 18 (mean age of 66.3, 10 males, 8 females) were found to have asymmetric levator function. A McNemar test was used to assess for a difference in the proportion of patients with correlated vs. opposing MRD and LF.
Of the 18 patients with asymmetric MRD and LF, 17 had lower LF on the same side as the lower MRD compared to 1 with the lower LF on the side with the higher MRD, (p<0.001).
In patients with asymmetric involutional blepharoptosis, LF was symmetric in 69% of patients. Of the remaining 31% with asymmetric LF, the majority (17 out of 18 patients) had lower LF on the side with the lower MRD, (p<0.001), suggesting a different disease pathophysiology in this subgroup than aponeurotic defect alone.
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