Blepharoptosis – 2

In this second article in the topic of blepharoptosis, we will have extensive discussion about preoperative care and diagnosis of blepharoptosis.

During the preoperative consultation, several tests are administered to measure the degree of blepharotosis and levator (eyelid lifting muscle) function. Each patient is categorized into one of the subcategories of mild ptosis, moderate ptosis, and severe ptosis.

Bell phenomenon (medical sign that allows observers to notice an upward and outward movement of the eye, when an attempt is made to close the eyes) is examined, and corneal sensitivity is tested. Whether the patient has dry eye syndrome or not is another factor to be considered. Because severe symptoms relating to the dry eye syndrome might be detrimental to the healing process of ptosis repair.

Moreover, synkinetic movement of the eyelid is tested and myasthenia gravis test is often administered, along with eye examination and Hering’s law test, which is used to explain the conjugacy of saccadic eye movement in stereoptic animals.

We test the function of eyelid to determine if the patient needs additional procedures such as ptosis repair or epicanthoplasty (eye surgery to remove epicanthal fold around inner corner of the eye) in conjunction with the double eyelid surgery. We measure the palpebral fissure length in the state of straight gaze. The palpebral fissure of typical Far-East Asian (Korean, Japanese, Chinese, etc) ranges from 8 mm to 8.5 mm. The method to measure the eye opening height is not standardized, yet but doctors often adopt some of the popular method such as, MDR1 (marginal reflex distance 1). Other methods to test the function of levator muscle and synkinetic movement of the eyelid include, Berke method, which is a test administered under restricted eyebrow motion, and MLD (marginal limbal distance), which measures the eye opening height in up gaze and static forehead muscle state.

With these various tests, we examine if the patient needs to undergo ptosis correction along with double eyelid fold creation. Blepharoptosis is such a challenging clinical problem that it is utterly important to find a doctor who are experts in the area as it the correction procedure is greatly affected by the doctor’s own experience of handling blepharoptosis.