Evaluation and Treatment of True Ptosis in Double Elevator Palsy.

Kim, Eun Ah; Lee, Sang Hyeok; Kim, Myung Mi; Chung, Wha Sun

Original Article

Journal of the Korean Ophthalmological Society 2005;46(3):389-395.
Published online March 31, 2005.

Evaluation and Treatment of True Ptosis in Double Elevator Palsy.

Eun Ah Kim, Sang Hyeok Lee, Myung Mi Kim, Wha Sun Chung

¹Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. shhlll@hanmail.net
²Dr. Chung's Eye Clinic, Daegu, Korea.

두눈올림근마비 환자의 눈꺼풀처짐에 대한 평가 및 치료

김은아¹,이상혁¹,김명미¹,정화선²

Department of Ophthalmology, Yeungnam University College of Medicine¹, Daegu, Korea Dr. Chung`s Eye Clinic², Daegu, Korea

Correspondence: Eun-Ah Kim, M.D.¹

Abstract

PURPOSE
To estimate the predictable factors of postoperative true ptosis remaining after squint surgery in patients with double elevator palsy (DEP), and to analyze the factors that must be considered before the correction of true ptosis. METHODS: We retrospectively reviewed the medical records of 6 patients who had undergone strabismus surgery for DEP at the Department of Ophthalmology, Yeungnam University College of Medicine, between 1989 and 2003. The MRD (margin reflex distance) of paretic and nonparetic eye with each eye fixation, palpebral aperture, levator function, and Bell's phenomenon were analyzed before and after squint surgery. RESULTS: True ptosis was noted in 3 patients, one of whom underwent external levator resection. Postoperative Bell's phenomenon improved in 2 patients who had poor Bell's phenomenon preoperatively. Scleral show remained in 2 patients who underwent inferior rectus recession, and was taken into account before the correction of ptosis. CONCLUSIONS: Upper lid drooping in DEP patients is expected to be improved after squint surgery if preoperative MRD of paretic eye with paretic eye fixation has the same measured amount as that of non-paretic eye. MRD, Bell's phenomenon and the amount of scleral show after the squint surgery should be carefully examined and assessed before the correction of residual ptosis.

Key Words: Double elevator palsy;Hypotropia;Margin reflex distance;Ptosis