Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, California, USA.
David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Orbit. 2022 Aug;41(4):464-468. doi: 10.1080/01676830.2021.1949725. Epub 2021 Jul 6.
Upper eyelid weighting decreases lagophthalmos by improving blink dynamics. The effect of weighting on static eyelid position is less well understood. This study describes the effect of upper eyelid weighting on ipsilateral and contralateral upper eyelid position.
Patients with unilateral lagophthalmos who underwent upper eyelid weight implantation were included. Primary outcome measures were ipsilateral and contralateral margin to reflex distance 1 (MRD1), preoperatively and postoperatively. MRD1 symmetry was assessed as a secondary outcome measure. Weight mass was examined as a covariate of MRD1 change.
23 patients (16 female, 7 male) met inclusion criteria. After weighting, contralateral MRD1 increased from mean [SD] 2.91 [1.41] mm to 3.77 [1.75] mm ( < .05). Ipsilateral (weighted) MRD1 did not significantly change (2.64 [1.41] mm to 2.40 [1.18] mm, = .11). Preoperatively, paretic and normal side MRD1 were not different ( = .52). Postoperatively, weighted and unweighted MRD1 were significantly different ( < .05). Weight mass was not a covariate of MRD1 change, neither ipsilateral nor contralateral ( = .76, = .71, respectively). The proportion of patients with MRD1 asymmetry ≥ 1 mm preoperatively (12/23, 52.2%) did not change following surgery (17/23, 73.9%, = .12).
Weight insertion led to contralateral eyelid elevation, a manifestation of Hering's law. Weight mass did not impact the magnitude of MRD1 change, and the proportion of patients with MRD1 asymmetry ≥ 1 mm did not change following surgery. These findings may guide surgeons in their preoperative planning and in counseling of patients.
上眼睑重量减轻通过改善眨眼动力学来减少睑裂闭合不全。但对于上眼睑重量减轻对上眼睑静态位置的影响，人们的了解较少。本研究描述了上眼睑重量减轻对上眼睑同侧和对侧位置的影响。
纳入了单侧睑裂闭合不全且接受上眼睑重量植入的患者。主要结局指标为术前和术后同侧和对侧反射距离 1（MRD1）的边缘到边缘距离。MRD1 对称性为次要结局指标。作为 MRD1 变化的协变量检查了重量质量。
23 名患者（16 名女性，7 名男性）符合纳入标准。在加权后，对侧 MRD1 从平均（标准差）2.91（1.41）mm 增加到 3.77（1.75）mm（<0.05）。同侧（加权）MRD1 无显著变化（2.64（1.41）mm 至 2.40（1.18）mm，=0.11）。术前，麻痹侧和正常侧的 MRD1 无差异（=0.52）。术后，加权和未加权的 MRD1 差异显著（<0.05）。重量质量不是 MRD1 变化的协变量，无论是同侧还是对侧（=0.76，=0.71）。术前 MRD1 不对称≥1mm 的患者比例（12/23，52.2%）在手术后没有改变（17/23，73.9%，=0.12）。
重量插入导致对侧眼睑抬高，这是 Hering 定律的表现。重量质量不影响 MRD1 变化的幅度，且术后 MRD1 不对称≥1mm 的患者比例无变化。这些发现可能指导外科医生进行术前计划和患者咨询。
