Intercanthal and interpupillary distance in the black population

Normal periocular anthropometric measurements in an Australian population

PURPOSE

To report the normative ocular and periocular anthropometric measurements in an Australian cohort and investigate how these may be affected age, gender, and ethnicity.

METHODS

Prospective study of patients presenting to the Royal Adelaide Hospital. Patient with orbital or eyelid disease, previous surgery, craniofacial abnormalities, pupil abnormalities, strabismus, and poor image quality was excluded. Standardised photographs were taken in a well-illuminated room. A green dot with a diameter of 24 mm was placed on the participant's foreheads for calibration between pixels and millimetres. Ocular and periocular landmarks were segmented to calculate the periorbital measurements. Independent sample t test was used to compare male and female subjects, Pearson's correlation was used to correlate periocular dimensions with age, and ANOVA with Bonferroni was used to compare periocular dimension between ethnic groups.

RESULTS

Seven hundred and sixty eyes from 380 participants (215 female, mean age 58 ± 18 years) were included. The mean marginal reflex distance (MRD) 1 was 3.5 mm and decreased with increasing age (r =  - 0.09, p = 0.01) and MRD 2 was 5.2 mm. Compared to Caucasians, African subjects had a significantly larger interpupillary distance and outer intercanthal distance, whereas East Asians had a significantly larger inner intercanthal distance (p < 0.05). The values of marginal reflex distance 2, palpebral fissure height, horizontal palpebral aperture, inner intercanthal distance, interpupillary distance and outer intercanthal distance were significantly higher in male subjects than female subjects (p < 0.05).

CONCLUSIONS

Normative periocular dimensions may vary according to age, gender, and ethnicity. An understanding of normal periocular dimensions is important in the evaluation of orbital disease across different ethnic groups and may serve as reference points for oculoplastic surgery and industry.

Expanding the Classic Facial Canons: Quantifying Intercanthal Distance in a Diverse Patient Population

Background:

The intercanthal distance (ICD) is central to our perception of facial proportions, and it varies according to gender and ethnicity. Current standardized reference values do not reflect the diversity among patients. Therefore, the authors sought to provide an evidence-based and gender/ethnicity-specific reference when evaluating patients’ ICD.

Methods:

As per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of PubMed, Medline, and Embase was carried out for studies reporting on the ICD. Demographics, study characteristics, and ICDs were extracted from included studies. ICD values were then pooled for each ethnicity and stratified by gender. The difference between men and women, and that across ethnicities and measurement types were compared by means of independent sample t-test and one-way ANOVA (SPSS v.24).

Results:

A total of 67 studies accounting for 22,638 patients and 118 ethnic cohorts were included in this pooled analysis. The most reported ethnicities were Middle Eastern (n = 6629) and Asian (n = 5473). ICD values (mm) in decreasing order were: African 38.5 ± 3.2, Asian 36.4 ± 1.6, Southeast Asian 32.8 ± 2.0, Hispanic 32.3 ± 2.0, White 31.4 ± 2.5, and Middle Eastern 31.2 ± 1.5. A statistically significant difference (P < 0.05) existed between all ethnic cohorts, between genders among most cohorts, and between most values stratified by measurement type.

Conclusions:

Our standards of craniofacial anthropometry must evolve from the neoclassical canons using White values as references. The values provided in this review can aid surgeons in appreciating the gender- and ethnic-specific differences in the ICD of their patients.

The Prevalence of Double Eyelid and the 3D Measurement of Orbital Soft Tissue in Malays and Chinese

This study aimed to determine the prevalence of double eyelid among two main Mongoloid ethnicities, the Malays and Chinese who reside in Malaysia. We also measured their periorbital tissue parameters for application in anthropology, optometry, ophthalmology, oculoplastic surgery and maxillofacial trauma surgery. The images of the 103 Malay and 97 Chinese volunteers were captured using indirect 3D photogrammetry, and quantitative measurement was obtained using the software provided by the manufacturer. All Malays and 70.1% of Chinese in this cross section population had double eyelid on both eyes. The mean pretarsal skin height was 3.99 mm for the Malays and 2.29 mm for the Chinese. The Malays appeared to have shorter eyebrow height (11.10 mm) compared to the Chinese (11.79 mm). An opposite pattern could be seen in the measurement of upper eyelid crease height between the Malays (8.33 mm) and the Chinese (4.91 mm). Of note, the intercanthal distance of the Chinese (IDC = 35.85 mm) was wider and their interpupillary distance was narrower (IPD = 62.85 mm) compared to the Malays' (ICD = 34.21 mm; IPD = 64.04 mm). In conclusion, there were significant differences in the prevalence of double eyelid and periorbital tissue measurements between the Malays and Chinese.

The relationship between innercanthal dimension and interalar width to the intercanine width of maxillary anterior teeth in central Indian population

Statement of Problem:

Selection of proper sized maxillary anterior teeth is one of the difficult clinical steps in complete denture esthetics. Several studies have been reported to establish methods of estimating the combined width of maxillary anterior teeth.

Purpose:

The aim of this study was to determine whether a relationship exists between the innercanthal distance (ICD) and interalar width (IAW) with the combined width of maxillary anterior teeth.

Material and Methods:

The maxillary anterior teeth of 600 adult subjects were examined. ICD was measured between the median angles of the palpebral fissure. IAW was measured between the ala of the nose at their widest point. The mean combined width of the maxillary anterior teeth was determined intraorally at their widest dimension. Pearson's correlation coefficients were calculated to determine the relationship between ICD, IAW and the combined width of maxillary anterior teeth (α =0.05).

Results:

Although the Pearson correlation coefficients were relatively small, a significant relationship existed between innercanthal dimension and IAW (P < 0001).

Conclusion:

Within the limitations of this study, the results suggest that ICD and IAW cannot be used as a preliminary method for determining the width of the maxillary anterior teeth for edentulous patients.

A new technique to determine vertical dimension of occlusion from anthropometric measurement of interpupillary distance

Background: A number of techniques are being practiced for the evaluation of VDO, but none of them is scientifically more accurate than other. Each method advocated has its own limitations. Objectives: The purpose of this study was to find correlation between vertical dimension of occlusion (VDO) and interpupillary distance (IPD). Material and Methods: A cross-sectional study was conducted on 400 dentate subjects comprising of 200 males and 200 females. Anthropometric measurement of VDO was recorded clinically using modified digital vernier caliper. Also, a standardized digital photograph of face was generated from the frontal aspect using a digital camera for the measurement of IPD in millimeters. Correlation between VDO and IPD was studied using Spearman’s coefficient. For the execution of regression command and preparation of prediction equations to estimate VDO, Statistical Package for Social Sciences (SPSS) Software Version 11.5 was used. Results: VDO and IPD was more in males compared to females. VDO was significantly and positively correlated with IPD only in males whereas females showed a weak correlation. Hence, regression equation was derived only for males. VDO estimation using regression equation for IPD had a standard error of ± 3.94 in males. Conclusions: Since the variations between VDO and IPD are within the range of 2-4 mm, VDO prediction through this method is reliable and reproducible for male patients. Also, the method is simple, economic, and non invasive; hence it could be recommended for everyday practice to determine vertical dimension of occlusion in case of male patients.

Key words:Anthropometry, interpupillary distance, jaw relation, vertical dimension of occlusion.

Biometric study of eyelid shape and dimensions of different races with references to beauty

BACKGROUND

There are few studies that evaluate the differences in the perception of beauty and attractiveness of different races or ethnicities. The purpose of this study was to determine whether there are any actual differences in the configuration of beautiful eyes among different races.

METHODS

Using seven composite faces of different races or ethnicities, photogrammetric measurements were performed to determine the relative differences in the average and attractive configuration of the eyes. Fourteen distance measurements and five angular measurements were performed for analyzing the morphological differences in the configuration of attractive and average faces.

RESULTS

The results of our study found that attractive Korean faces have relatively wide-set eyes and that the medial and lateral eye fissure height is greater than that in average Korean faces. Attractive Korean faces have larger but not ptotic eyes than those in average Korean faces and they have a narrow double fold line; however, attractive Asian faces have a slightly higher double fold line. Attractive Korean or Asian faces do not have an epicanthus and there is a lot of exposure of white in the medial and lateral area of the eyes. Attractive Caucasian and African faces have an acute or keen shape to the eyes like the jaguar's eye. Attractive Asian faces have a less steep slant of the palpebral fissure compared to that of the average Asian face, but attractive Caucasian and African faces have a steeper palpebral slant than that of average Caucasian and African faces. Attractive Caucasian and African faces have a relatively narrower palpebral fissure height and width than average Caucasian and African faces. Regardless of race, attractive faces have wide-set eyes and a lower brow position than average faces.

CONCLUSIONS

"Beautiful eyes" can be defined as youthful, brilliant, vivid, and attractive. We found that there are some common and some different characteristics in the configuration of beautiful eyes according to racial background.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article.

Orbito-ocular soft tissue measurements in young adults--an indigenous Negro population study

AIM

This study was named at determining normal orbital soft tissue parameters in young adults in an indigenous black population.

METHODOLOGY

Prospective study on consentimg young adults in a Nigerian University with no previous orbito-facial trauma/surgery, strabismus, ptosis, telecanthus, and history of neurological diseases or previous ocular trauma were excluded. The age, sex and height of each participant were recorded. With the aid of a manual Sliding Vernier Caliper, the inner canthal distance (ICD), outer canthal distance (OCD), right horizontal palpebrae fissure length (RHPFL), left horizontal palpebrae fissure length (LHPFL). The results were imputed, analyzed and reported as simple frequency, means and standard deviations using the SPSS version 11 and statistical significant accepted at P < 0.05.

RESULTS

Two hundred and four of participants of which 136 (66.7%) were males constituted the study population. Their ages ranged between 17-38 years with a mean and standard deviation of 23.6 ± 3.2 years. Their height ranged from 1.43-1.94 m with a mean and standard deviation of 1.70 ± 0.81 m. The mean and standard deviation for OCD, ICD, RHPFL and LHPFL were 99.6 ± 5.5 mm, 36.5 ± 3.3 mm, 32.5 ± 1.8 mm and 31.7 ± 1.9 mm, respectively. The range and mean ICD (28.2-45.4 mm and 36.5 mm) is greater than the range and mean palpebrae fissure lengths in either eye. Statistcally significant gender based differences were recorded in the mean OCD and ICD with higher values in in males.

CONCLUSION

Normal soft tissue orbit-ocular parameters are presented for young adults in the population showing statistically significant mean larger values for males compared with female subjects.

Biometric ratio in estimating widths of maxillary anterior teeth derived after correlating anthropometric measurements with dental measurements

OBJECTIVE

To correlate dental measurements i.e. combined mesiodistal width of six maxillary anterior teeth with facial measurements i.e. inner canthal distance, interpupillary distance and intercommissural width and acquire a biometric ratio to serve as a preliminary guide in selection of the maxillary anterior teeth.

BACKGROUND

In the absence of pre-extraction records, the resultant denture can lead to patient dissatisfaction towards the aesthetic appeal of their dentures. The maxillary anterior teeth play a pivotal role in denture aesthetics. Various techniques and biometric ratios have been described in literature for selection of the maxillary anteriors. This study derives a biometric ratio for the same, obtained after correlating anthropometric measurements with dental measurements.

MATERIALS AND METHODS

Two standardized digital photographs of the face were generated; one, when the facial muscles were relaxed and the other, when the subject was smiling; thereby, revealing the maxillary anterior teeth upto the canine tip. Inner canthal distance, interpupillary distance, intercommissural distance, distance between the tips of the maxillary canines and distance between the distal surfaces of the canines were measured. On the cast, the distance between tips of maxillary canines and distance between distal surfaces of maxillary canines were noted. The data was analysed using Spearman's rank correlation coefficient.

RESULTS

A high correlation was found between the intercommissural measurement with distance between the tips of the canines on the photograph and between the tips of the canines on the cast with the interpupillary distance, giving a biometric ratio of 1:1.35 and 1:1.41 respectively. The least correlation was between the inner canthal distance and the tips of the canines measured on the photograph.

CONCLUSIONS

Extra oral anthropometric measurements of the interpupillary distances and the intercommissural distances with the help of standardised photographs can help us determine the combined widths of the anterior teeth accurately, thus aiding their selection in the absence of pre-extraction records.

Correlation between Facial Measurements and the Mesiodistal Width of the Maxillary Anterior Teeth

One of the most difficult aspects during the selection of maxillary anterior teeth for a removable prosthesis is determining the appropriate mesiodistal width of the six maxillary anterior teeth. Many attempts have been made to establish methods of estimating the combined width of these anterior teeth, and improving the esthetic outcome. The proportion of facial structures and the relationship between facial measurements and natural teeth could be used as a guide in selecting denture teeth. The aim of this study was to verify the relation between the combined mesiodistal width of the six maxillary anterior teeth and the facial segments: the width of the eyes, the inner canthal distance (ICD), the interpupillary distance (IPD), the interalar width, and the intercommissural width (ICm). Standardized digital images of 81 dentate Brazilian subjects were used to measure both facial and oral segments when viewed from the frontal aspect through an image processing program. To measure the distance between the upper canines on a curve, accurate casts were made from the upper right first premolar to the upper left first premolar. The Spearman rank correlation coefficient was conducted to measure the strength of the associations between the variables (alpha = 0.05). The results showed a significant correlation between all facial elements and the combined mesiodistal width of the six teeth, when observed from the frontal aspect. The ICD, IPD, and ICm showed the highest probability of being correlated to the mesiodistal width of the teeth (p = 0.000).

CLINICAL SIGNIFICANCE

This article considers facial analysis with digital photography as a practical and efficient application to select the mesiodistal width of artificial anterior teeth in an esthetically pleasing and natural appearance during an oral rehabilitation treatment.

High Altitude and the Eye: A Case Controlled Study in Clinical Ocular Anthropometry of Changes in the Eye

Tribal natives of two spatially separate districts of Lahaul-Spiti (mean altitude = 3300 m) and Kinnaur (mean altitude = 1,700 m) in the Himalayan state of Himachal Pradesh have lived for centuries as closed isolated groups, marrying within the local community up to the recent past. Studies on highland natives in the Andes have shown differences in chest diameters, lung volumes, hematocrit, and the like, in those living at high altitudes. We wanted to study whether stay at high altitude for generations confers any change in the ocular anthropometry. No study of this nature is available in the literature. We studied the ocular parameters using Snellen's charts, Standard Royal-Air-Force Rule, A-2,500 Sonomed A-Scan, Goldmann's aplanation tonometer, and S-7,000 Autorefractometer on 50 healthy volunteers at the Indira Gandhi Medical College Out Patient Department at Shimla (mean altitude = 2,100 m). Those living at higher altitudes in Lahaul-Spiti [LS] (n = 10) had significantly wider nose bridge width (p < 0.05); inter-inner canthal distance [IICD] (p < 0.05); inter-outer canthal distance [IOCD] (p < 0.05); and interpupillary distance [IPD] (p < 0.05) than the group living at Kinnaur (n = 40) at lower elevation. The LS group also had narrower palpebral fissure length in the vertical dimension (p = 0.05) and a lower IOP (p = 0.002) than the Kinnaur group. The axial length, lens thickness, and anterior chamber depth were comparable in the two groups. It appears that the eye and its adnexa respond to hypoxia, ultraviolet radiations, and persistent snow cover at high altitude by altering its anthropometry in a subtle but discernible manner. This was a hitherto unexplored area in the literature. Further studies to elucidate and substantiate the findings of the study are indicated.

Craniofacial anthropometry in a Turkish population

OBJECTIVE

To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects.

PARTICIPANTS

Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study.

METHODS

Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age.

RESULTS

The fronto-occipital circumference and outer canthal distance of males was significantly (p <.001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p <.001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population.

CONCLUSION

This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.

The relationship between intercanthal dimension and the widths of maxillary anterior teeth

STATEMENT OF PROBLEM

One of the difficult aspects of complete denture prosthodontics is the selection of appropriately sized maxillary anterior teeth. Many attempts have been made to establish methods of estimating the combined width of maxillary anterior teeth and/or central incisors.

PURPOSE

The aim of this investigation was to determine whether a relationship exists between the intercanthal dimension and 4 mesiodistal width combinations of the maxillary anterior teeth.

MATERIAL AND METHODS

The maxillary anterior teeth of 443 adult subjects were examined. Intercanthal distance was measured between the median angles of the palpebral fissure. The mean widths of the 2 central incisors, the combined widths of the central incisors, the combined width of the 4 incisors, and the combined width of the 6 anterior teeth were determined intraorally at their widest dimension. Pearson correlation coefficients were calculated to determine the relationship between intercanthal distance and the 4 measurements of maxillary anterior teeth (alpha=.05).

RESULTS

Although the Pearson correlation coefficients were relatively small, a significant relationship existed between intercanthal dimension and the 4 maxillary teeth dimensions (P<.0001). It was found that biometric ratios of 1:0.267 and 1:1.426 could be used to estimate the central incisor width and the combined widths of the 6 anterior teeth, respectively.

CONCLUSION

Within the limitations of this study, the results suggest that intercanthal distance can be used as a preliminary method for determining the width of the maxillary anterior teeth for edentulous patients.

Interpupillary index: a new parameter for hypo-hypertelorism

AIM

To establish a new clinical index to evaluate the presence of hypo-hypertelorism with greater accuracy.

MATERIAL AND METHODS

After screening a wide range of population, 310 elementary school children (185 boys, 125 girls) aged 7-15 years were included in this study. For this cross-sectional study, a millimetre ruler was used. The anatomical interpupillary distance was measured by a modified Viktorin's method. In addition, inner and outer intercanthal distances were obtained. The data were analyzed by Student's t-test for two independent samples using SPSS for Windows. There were children with clinical hypertelorism (n = 92, group 1), children with large fronto-occipital circumference (FOC) (n = 101, group 2), and age- and sex-matched normal controls (n = 117, group 3). Due to variations in FOC among healthy subjects, we introduced a new practical concept for evaluation of interpupillary distance, namely the interpupillary index, the simple product obtained by dividing the interpupillary distance by the FOC, multiplied by 100.

RESULTS

The overall idiopathic benign macrocephalic children (group 2) had significantly (p < 0.001) larger interpupillary distances (6.13 +/- 0.36 cm) and FOCs (56.99 +/- 1.46 cm) than those of normal controls (5.70 +/- 0.26cm and 52.82 +/- 1.22 cm, respectively). But, the difference between the combined product of interpupillary distance and FOC, the interpupillary index, was not significant (10.76 +/- 0.50 and 10.79 +/- 0.35, respectively) (p > 0.05). On the other hand, the children with hypertelorism had significantly (p < 0.001) larger interpupillary distances (6.47 +/- 0.29cm) and FOCs (54.90 +/- 2.18cm) when compared with the controls. In addition, the interpupillary index was significantly (p < 0.001) higher (11.80 +/- 0.45) than both macrocephalic children (10.76 +/- 0.50) and controls (10.79 +/- 0.35). Intercanthal distances and intercanthal index of hyperteloric children were also significantly (p<0.001) larger than both macrocephalic children and controls.

CONCLUSION

This new index offers a new concept for more accurate evaluation of the presence of ocular hypo-hypertelorism.

Orbital measurement in black and white populations

OBJECTIVE

Obtain measurements of globe projection, intercanthal distance (ICD), interpupillary distance (IPD), palpebral fissure width (PFW), and palpebral fissure height (PFH) in a population of presumably normal white and black adults to determine if any significant differences exist between these groups.

STUDY DESIGN

Prospective direct measurement of cohorts regarding orbital and globe measurements in a tertiary medical center.

METHODS

Measurements of globe projection, ICD, IPD, PFW, and PFH were taken in 61 black adults and directly compared with measures taken from 65 white adults in an outpatient setting. Mean values and ranges were calculated and compared between races and sexes using an unpaired t test.

RESULTS

A significant difference was found between races for globe projection, with black males demonstrating a mean projection of 18.23+/-2.26 mm as compared with 17+/-2.65 mm for white males (P < .025). Black females demonstrated a mean projection of 17.27+/-1.44 mm as compared with 15.98+/-2.22 mm for white females (P < .01). Similar differences were seen for measures of IPD and PFW, with greater mean values for black as compared with white adults. No racial differences existed for ICD or PFH.

CONCLUSIONS

These findings suggest that racial differences exist for certain measures of globe and orbital position, i.e., projection, IPD, and PFW. Racial background should be considered when evaluating orbital anatomy.