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Sunken eyeballs5/17/2023 Forty-five patients were male and 41 were female. Patients with glaucoma, visual acuity less than 16/20, SES with a vertical strabismus angle of 6 Δ or more, IXT that could not be maintained in the phoria position during photography, a history of previous oculoplastic or ophthalmic surgery, and those using prostaglandin analogs for cosmetic purposes were excluded.Ī total of 86 patients were included: 23 with SES, 28 with IXT, and 35 in the control group. The average scores for each parameter among the three groups were analyzed. Three ophthalmologists evaluated each eye for sunken upper eyelid, blepharoptosis, and baggy lower eyelid, using a scoring scale. We evaluated frontal facial photographs of patients aged > 60 years with SES and intermittent exotropia (IXT), and control patients who visited the ophthalmology outpatient clinics of two institutions between June 2020 and December 2021. To compare the facial features of patients with sagging eye syndrome (SES) and other ophthalmic diseases, and to evaluate the diagnostic usefulness of facial features for SES. The aspect ratio thus has the potential to be a new parameter for blepharoptosis. The aspect ratio of each palpebral fissure (the percentage of height to width) reflected the progression of blepharoptosis and the post-operative changes. In the re-operated patients, the difference between the right and left sides decreased significantly from 6.7 to 1.9% post-revision. In the eight patients who underwent re-operation, the revised side’s vertical percentage was not improved after the first operation (from 28.0 to 31.3%), and the revision significantly changed the vertical percentage to 39.0%. In the 18 unilateral cases, the affected side showed significant improvement in vertical percentage (from 29.6 to 38.7%), while the unaffected side showed no change. In the 77 bilateral cases, both sides showed significant improvement in vertical percentage (from 28.9 to 37.3%, right) and (28.7 to 36.1%, left). The MRD and the vertical percentage values were strongly correlated (correlation coefficient 0.766). We calculated the percentage of the vertical side (height) to the horizontal side (width) and defined this value as the vertical percentage of the palpebral fissure. We set a rectangle with the vertical sides at the lateral and medial canthus and the horizontal sides at the highest and lowest points of the eyelids. We digitally analyzed pre- and post-operative photographs of 95 patients with blepharoptosis. The effects fill the hollowness of the upper eyelid and can remarkably improve sunken eyes.Īlthough the margin reflex distance (MRD) is widely used to assess blepharoptosis, it has some drawbacks (e.g. The principal aim of levator resection is to improve upper eyelid height and visual fields however, this technique can alter the location of the eyebrow and upper orbital fat. The AES change was significantly correlated to the EBH change (P < 0.0001 r = 0.5184).Ĭonclusions. Mean margin reflex distance significantly increased, whereas mean EBH and mean AES significantly decreased at 3 months after surgery (P < 0.0001). Sunken eyes were remarkably improved after levator resection in all patients. Preoperative AES was significantly correlated to age (P < 0.0001 r = 0.8062). In addition, margin reflex distance, eyebrow height (EBH), and AES were measured before and 3 months after surgery to assess the changes in the eyelids. The digital images were converted to black and white using image-processing software (Adobe Photoshop), and the AES was calculated using ImageJ software. Area of upper eyelid sulcus (AES) was defined as the area of the upper eyelid shadow. Advancement of the levator aponeurosis and the Müller’s muscle complex (levator resection) was performed in these patients. Analysis involved 60 eyes from 32 patients with sunken eyes combined with blepharoptosis. This study aims to report the changes in sunken eyes combined with blepharoptosis after levator resection.
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