Effect of Low-Concentration, Nonmydriatic Selective Alpha-Adrenergic Agonist Eyedrops on Upper Eyelid Position.

BACKGROUND: Ptosis after botulinum toxin injection is a disturbing complication. Decongestant and antiglaucoma eyedrops are frequently prescribed for temporary improvement of eyelid ptosis. Although frequently cited on informal communications, the effect of these drugs on eyelid position has never been compared in a formal study. OBJECTIVE: To measure the effect of low-concentration, nonmydriatic selective alpha agonist eyedrops on upper eyelid position. METHODS AND MATERIALS: This nonrandomized clinical trial enrolled 20 healthy subjects aged 18 to 50 years. The upper margin-reflex distance (MRD1) was measured before, 30, 60, and 120 minutes after administration of 1 drop of brimonidine 0.2%, phenylephrine 0.12%, or naphazoline 0.05% to the left eye. RESULTS: There was no statistically significant difference in mean MRD1 between the brimonidine and phenylephrine groups when comparing baseline to all other study time points. After administration of naphazoline 0.05%, MRD1 had a mean increase of 0.56 ± 0.11 mm (p < 0.001) after 30 minutes, 0.47 ± 0.12 mm (p = 0.001) after 60 minutes, and 0.26 ± 0.09 mm (p = 0.028) after 120 minutes when compared with baseline. CONCLUSION: Brimonidine 0.2% and phenylephrine 0.12% have no effect on eyelid aperture, but naphazoline 0.05% eyedrops could be useful for temporary relief of upper eyelid ptosis in selected patients.

Characterization of Normal Mediolateral Angular Direction of Lower Eyelid Eyelashes in Different Age Groups.

PURPOSE: To characterize the normal eyelash mediolateral angular direction of the lower eyelid in different age groups. METHODS: Sixty patients were divided into 3 groups: G1 - 6 to 12 years; G2 - 20 to 35; and G3 - 60 to 85. Digital photographs were obtained and eyelids were divided in lateral, central, and medial portions. Eyelash mediolateral angular direction relative to a baseline was measured and data were compared between portions and groups. RESULTS: The mean eyelash mediolateral angular direction in the medial portion were: G1: 133.79° ± 17.56° SD; G2: 137.74° ± 10.5° SD; and G3: 116.05° ± 26.71° SD. The mean difference in angle between G1 and G3 was 17.74° (p = 0.015) and between G2 and G3 was 21.69° (p = 0.000). The mean eyelash mediolateral angular direction in central portion were: G1: 64.36° ± 12.58° SD; G2: 77.07° ± 12.17° SD; and G3: 84.9° ± 18.48° SD. The mean difference between Group 1 and 2 was 12.71° (p = 0.001) and between Group 1 and 3 was 20.54° (p = 0.000). The mean eyelash mediolateral angular direction in the lateral portion were: Group 1: 40.57° ± 6.78° SD; Group 2: 37.21° ± 5.69° SD; and Group 3: 38.48° ± 8.35° SD. CONCLUSION: This study identified that lashes in the lateral portion of lower eyelid tend to maintain the same angular position throughout life. On the central and medial portions it tends to approach a 90° angle with age. The authors believe that this modification throughout life may be related to factors, such as involutional horizontal eyelid laxity and orbicular muscle modifications.