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Shoji MK, Markatia Z, Ameli K, Bayaraa M, Clauss KD, Ugradar S, Lee WW. The Effect of Topical Oxymetazoline on Eyelid Position, Eye Redness, and Patient-Reported Eye Appearance: A Randomized Controlled Trial. J Plast Reconstr Aesthet Surg 2023; 80:66-74. [PMID: 36996503 DOI: 10.1016/j.bjps.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE This study assesses the effects of topical oxymetazoline 0.1% on eyelid position, eye redness, and patient-perceived eye appearance in patients without severe ptosis. METHODS This is a randomized double-blinded controlled trial conducted at a single institute. Patients aged 18-100 years were randomized to receive one drop of oxymetazoline hydrochloride 0.1% or placebo bilaterally. Marginal reflex distance (MRD) 1 and 2, palpebral fissure height, eye redness, and patient-perceived eye appearance were assessed at baseline and two hours after drop instillation. Primary outcome measures included the change in MRD1, MRD2, and palpebral fissure height. Secondary outcome measures included changes in eye redness and patient-perceived eye appearance after drop instillation. RESULTS In total, 114 patients were included, 57 treatment patients (mean age 36.4 ± 12.7 years, 31.6% male) and 57 controls (mean age 31.3 ± 10.1 years, 33.3% male). Baseline mean MRD1, MRD2, and palpebral fissure were similar between groups (p = 0.24, 0.45, and 0.23, respectively). Changes in MRD1 and eye redness in the treatment group were significantly greater than those in the control group (0.9 ± 0.9 mm vs. - 0.3 ± 0.4 mm, p < 0.001; - 2.6 ± 4.4 vs. - 0.5 ± 2.3, p = 0.002, respectively). Patient-perceived eye appearance was significantly improved in the treatment group compared to the controls (p = 0.002), with more treatment group patients also reporting increased eye size and decreased eye redness (p = 0.008, p = 0.003, respectively). There were 9 treatment-emergent adverse events (TEAEs) in 7 treatment group patients and 5 TEAEs in 5 control patients (p = 0.25), all of which were mild in severity. CONCLUSIONS Topical oxymetazoline 0.1% increases MRD1 and palpebral fissure height, decreases eye redness, and improves patient-perceived eye appearance.
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Affiliation(s)
- Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Zahra Markatia
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Kambiz Ameli
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Mandah Bayaraa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Kevin D Clauss
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Shoaib Ugradar
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Wendy W Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America.
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Nielsen TA, Andersen CU, Vorum H, Riahi S, Sega R, Drewes AM, Karmisholt J, Jakobsen PE, Brock B, Brock C. Palpebral Fissure Response to Phenylephrine Indicates Autonomic Dysfunction in Patients With Type 1 Diabetes and Polyneuropathy. Invest Ophthalmol Vis Sci 2022; 63:21. [PMID: 35980646 PMCID: PMC9404365 DOI: 10.1167/iovs.63.9.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The superior and inferior tarsal muscles are sympathetically innervated smooth muscles. Long-term diabetes often leads to microvascular complications, such as, retinopathy and autonomic neuropathy. We hypothesized that diabetes induces (1) sympathetic paresis in the superior and inferior tarsal muscles and that this measure is associated with (2) the severity of diabetic retinopathy, (3) the duration of diabetes, and (4) autonomic function. In addition, association between the severity of retinopathy and autonomic function was investigated. Methods Forty-eight participants with long-term type 1 diabetes and confirmed distal symmetrical polyneuropathy were included. Palpebral fissure heights were measured bilaterally in response to topically applied 10% phenylephrine to the right eye. The presence of proliferative diabetic retinopathy (PDR) or nonproliferative diabetic retinopathy and disease duration were denoted. Time and frequency derived heart rate variability parameters obtained from 24-hour continuous electrocardiography were recorded. Results The difference in palpebral fissure heights between phenylephrine treated and untreated eyes (∆PFH) was 1.02 mm ± 0.29 (P = 0.001). The ∆PFH was significantly lower in the PDR group (0.41 mm ± 0.43 vs. 1.27 mm ± 1.0), F(1,35) = 5.26, P = 0.011. The ∆PFH was lower with increasing diabetes duration, r(37) = -0.612, P = 0.000. Further, the ∆PFH was lower with diminished autonomic function assessed as total frequency power in electrocardiogram (r = 0.417, P = 0.014), and sympathetic measures of very low (r = 0.437, P = 0.010) and low frequency power (r = 0.384, P = 0.025). Conclusions The ∆PFH is a simple ambulatory sympathetic measure, which was associated with the presence of PDR, disease duration, and autonomic function. Consequently, ∆PFH could potentially be an inexpensive and sensitive clinical indicator of autonomic dysfunction.
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Affiliation(s)
- Thomas Arendt Nielsen
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Carl Uggerhøj Andersen
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
| | - Rok Sega
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.,Department of Ophthalmology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.,Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Jesper Karmisholt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Poul Erik Jakobsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.,Steno Diabetes Center North Denmark, Aalborg, Denmark
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Ugradar S, Kim JS, Trost N, Parunakian E, Zimmerman E, Ameli K, Shoji MK, Lee WW. Changes to Eye Whiteness and Eyelid/Brow Position With Topical Oxymetazoline in Aesthetic Patients. Aesthet Surg J 2022; 42:582-589. [PMID: 34962512 DOI: 10.1093/asj/sjab400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oxymetazoline hydrochloride 0.1% ophthalmic solution has recently been approved in the United States for the treatment of ptosis. OBJECTIVES The aim of this study was to assess the upper and lower eyelid position as well as the brow position and the color of the sclera following the ophthalmic administration of oxymetazoline hydrochloride 0.1%. METHODS In this prospective cohort study, consecutive patients presenting with ptosis received topical oxymetazoline 0.1%. The primary outcome was measurement of the upper eyelid height (margin-to-reflex distance 1 [MRD1]) and lower eyelid height (MRD2) relative to the center of pupil, along with assessment of brow height, measured on photographs at baseline and 2 hours after instillation of oxymetazoline. The secondary outcome was the assessment of the color of the sclera (eye whiteness) before and after treatment with a novel color space algorithm. RESULTS Twenty-nine patients participated in the study. The mean [SD] MRD1 at baseline was 2.3 [0.6] mm. At 2 hours following oxymetazoline treatment, the mean MRD1 significantly increased to 4.2 [0.9] mm (P < 0.01). The mean MRD2 also significantly increased from 5.3 [0.9] mm to 5.7 [1.0] mm (P < 0.01). Brow position did not change with treatment (P = 0.4). Following treatment, the eye sclera became significantly whiter, with a mean ΔEab (color change) of 9.7 [3.9], with 57 out of 58 eyes experiencing a significant change in color. A change of ΔEab ≥2 is considered visually perceptible to the human eye. CONCLUSIONS Within 2 hours of use, oxymetazoline significantly improves the size of the palpebral aperture (MRD1 + MRD2) and also makes the eye appear significantly whiter. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Shoaib Ugradar
- The Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA
| | - Jane S Kim
- Kellog Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Noelle Trost
- The Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA
| | | | - Erin Zimmerman
- The Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA
| | - Kambiz Ameli
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Marissa K Shoji
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Wendy W Lee
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
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Wirta DL, Korenfeld MS, Foster S, Smyth-Medina R, Bacharach J, Kannarr SR, Jaros MJ, Slonim CB. Safety of Once-Daily Oxymetazoline HCl Ophthalmic Solution, 0.1% in Patients with Acquired Blepharoptosis: Results from Four Randomized, Double-Masked Clinical Trials. Clin Ophthalmol 2021; 15:4035-4048. [PMID: 34675472 PMCID: PMC8517985 DOI: 10.2147/opth.s322326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose An oxymetazoline 0.1% ophthalmic solution was recently approved for treatment of acquired blepharoptosis in adults. This study's objective was to evaluate the safety profile of oxymetazoline 0.1% when administered once daily for 14-84 days. Patients and Methods Pooled analysis examined safety outcomes from four randomized, double-masked, placebo-controlled clinical trials conducted at 6, 16, 27, and 35 sites, respectively, in the United States. In total, 568 participants with acquired blepharoptosis were evaluated. Median age was 66 years and 74.8% of participants were female. Overall, 375 participants self-administered oxymetazoline 0.1% to both eyes once/day and 193 self-administered placebo (vehicle) daily. Treatment-emergent adverse event (TEAE) rates, severity, and causality were evaluated in the overall population and within participant subgroups defined based on age, race, and ethnicity. Vital signs and ophthalmic findings were evaluated at predefined study visits. Patient-reported treatment tolerability was recorded at study end. Results TEAE incidence was similar among participants using oxymetazoline 0.1% (31.2%) or vehicle (30.6%). Nearly all TEAEs were mild-to-moderate, and most were not suspected of being treatment related. Serious TEAEs occurred in four participants receiving oxymetazoline 0.1% and one participant receiving vehicle. Nine and two participants in the oxymetazoline 0.1% and vehicle groups, respectively, discontinued due to a TEAE. Ocular TEAEs occurring in ≥2% of participants receiving oxymetazoline 0.1% were punctate keratitis, conjunctival hyperemia, dry eye, blurred vision, instillation site pain, and corneal vital dye staining, with none occurring in >3.5% of participants. TEAE rates were similar across subgroups based on age, race, and ethnicity. No clinically significant mean changes in vital signs or ophthalmologic findings occurred, and >98% of participants rated oxymetazoline 0.1% as causing no/mild discomfort. Conclusion Once-daily oxymetazoline 0.1% was safe and well tolerated in participants with acquired blepharoptosis when used for 14-84 days. Safety did not appear to differ based on age, race, or ethnicity.
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Affiliation(s)
- David L Wirta
- Aesthetic Eye Care Institute & Eye Research Foundation, Newport Beach, CA, USA
| | | | | | | | | | | | | | - Charles B Slonim
- Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Slonim CB, Foster S, Jaros M, Kannarr SR, Korenfeld MS, Smyth-Medina R, Wirta DL. Association of Oxymetazoline Hydrochloride, 0.1%, Solution Administration With Visual Field in Acquired Ptosis: A Pooled Analysis of 2 Randomized Clinical Trials. JAMA Ophthalmol 2021; 138:1168-1175. [PMID: 33001144 PMCID: PMC7530825 DOI: 10.1001/jamaophthalmol.2020.3812] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Treatment of acquired blepharoptosis (ptosis) is currently limited to surgical intervention. Objective To examine the efficacy and safety of oxymetazoline hydrochloride, 0.1%, ophthalmic solution (oxymetazoline, 0.1%) in participants with acquired ptosis. Design, Setting, and Participants This pooled analysis of 2 randomized, double-masked, placebo-controlled, multicenter phase 3 clinical trials included participants 9 years and older with acquired ptosis and superior visual field deficit. The 2 studies were conducted across 16 and 27 sites in the United States. Patients were enrolled from May 2015 to April 2019. Analyses for the individual trials were initiated after database lock and completed on September 6, 2017, and May 16, 2019. Pooled analysis was completed on August 25, 2019. Interventions Participants (randomized 2:1) received oxymetazoline, 0.1%, or vehicle, self-administered as a single drop per eye, once daily, for 42 days. Main Outcomes and Measures The primary efficacy end point was change from baseline in the number of points seen on the Leicester Peripheral Field Test, a test to detect superior visual field deficits due to ptosis, on days 1 (6 hours after instillation) and 14 (2 hours after instillation). The secondary end point, change from baseline in marginal reflex distance 1, was assessed at the same time points. Results In total, 304 participants were enrolled (mean [SD] age, 63.8 [13.8] years; 222 women [73%]). Overall, 97.5% (198 of 203) of participants receiving oxymetazoline, 0.1%, and 97.0% (98 of 101) of participants receiving vehicle completed the studies. Oxymetazoline, 0.1%, was associated with a significant increase in the mean (SD) number of points seen on the Leicester Peripheral Field Test vs vehicle (day 1: 5.9 [6.4] vs 1.8 [4.1]; mean difference, 4.07 [95% CI, 2.74-5.39]; P < .001; day 14: 7.1 [5.9] vs 2.4 [5.5]; mean difference, 4.74 [95% CI, 3.43-6.04]; P < .001). Oxymetazoline, 0.1%, also was associated with a significant increase in marginal reflex distance 1 from baseline (mean [SD]: day 1: 0.96 [0.89] mm vs 0.50 [0.81] mm; mean difference, 0.47 mm [95% CI, 0.27-0.67]; P < .001; day 14: 1.16 [0.87] mm vs 0.50 [0.80] mm; mean difference, 0.67 mm [95% CI, 0.46-0.88]; P < .001). Treatment-emergent adverse events (TEAEs) occurred in 31.0% (63 of 203) of participants receiving oxymetazoline, 0.1%, and 35.6% (36 of 101) of participants receiving vehicle. Among participants receiving oxymetazoline, 0.1%, with a TEAE, 81% (51 of 63) had a maximum TEAE intensity of mild, and 62% (39 of 63) had no TEAE suspected of being treatment related. Conclusions and Relevance Oxymetazoline, 0.1%, was associated with positive outcomes and was well tolerated in phase 3 trials after instillation at days 1 and 14, demonstrating its potential promise for the treatment of acquired ptosis, although further study is needed to elucidate the clinical relevance of these findings beyond 6 weeks.
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Affiliation(s)
- Charles B Slonim
- Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa
| | | | | | | | | | | | - David L Wirta
- Aesthetic Eye Care Institute & Eye Research Foundation, Newport Beach, California
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Bacharach J, Wirta DL, Smyth-Medina R, Korenfeld MS, Kannarr SR, Foster S, J Jaros M, Slonim CB. Rapid and Sustained Eyelid Elevation in Acquired Blepharoptosis with Oxymetazoline 0.1%: Randomized Phase 3 Trial Results. Clin Ophthalmol 2021; 15:2743-2751. [PMID: 34211263 PMCID: PMC8240850 DOI: 10.2147/opth.s306155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Oxymetazoline 0.1% is a novel ophthalmic agent for the treatment of acquired blepharoptosis in adults that has been shown to improve upper eyelid elevation and superior visual field deficits. This analysis characterized the rapid onset of upper eyelid elevation with once-daily oxymetazoline 0.1% and durability of this effect over 42 days. Materials and Methods Pooling data from two prospective, randomized, placebo-controlled, phase 3 studies, change in marginal reflex distance 1 (MRD-1) was evaluated at a range of post-instillation time points on treatment days 1, 14, and 42. Onset of effect was assessed beginning at 5 minutes post-administration (one study) and through 6 hours at the first two visits (both studies). Overall, 203 subjects received oxymetazoline 0.1% and 101 received vehicle. Results Oxymetazoline 0.1% demonstrated a rapid onset of action on all days evaluated. Mean changes from baseline 5 and 15 minutes post-oxymetazoline 0.1% instillation on day 1 were 0.59 ± 0.72 mm and 0.93 ± 0.81 mm, respectively (vs 0.20 ± 0.57 mm and 0.32 ± 0.64 mm with vehicle; both p<0.001). On day 14, mean changes from baseline 5 and 15 minutes post-oxymetazoline 0.1% instillation were 0.77 ± 0.85 mm and 1.11 ± 0.92 mm, respectively (vs 0.42 ± 0.78 mm and 0.41 ± 0.83 mm with vehicle; both p<0.05). This effect was also observed immediately post-instillation on day 42, where mean increases 5 and 15 minutes post-oxymetazoline 0.1% instillation were 0.86 ± 0.85 mm and 1.04 ± 0.91 mm, respectively (vs 0.42 ± 0.80 mm and 0.47 ± 0.93 mm with vehicle; both p<0.005). Significant improvements vs vehicle (p<0.001) were also observed at 2–6 hours on days 1 and 14. At all time points, the proportion of subjects showing a positive response to treatment (>0% MRD-1 increase) was >15% greater in the oxymetazoline 0.1% group (range 16.6–36.1% more responders vs vehicle), with the largest differences observed 2 and 6 hours post-instillation. Conclusion Oxymetazoline 0.1% provided rapid and sustained upper eyelid elevation. Together with data demonstrating superior visual field improvement and a favorable safety profile, this analysis supports oxymetazoline 0.1% as an effective non-surgical treatment for acquired ptosis.
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Affiliation(s)
| | - David L Wirta
- Aesthetic Eye Care Institute & Eye Research Foundation, Newport Beach, CA, USA
| | | | | | | | | | | | - Charles B Slonim
- Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Bacharach J, Lee WW, Harrison AR, Freddo TF. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond) 2021; 35:2468-2481. [PMID: 33927356 PMCID: PMC8376882 DOI: 10.1038/s41433-021-01547-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.
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Affiliation(s)
| | - Wendy W Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
| | - Thomas F Freddo
- Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA
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Lee SH, Kang SM. Iatrogenic Horner’s Syndrome Developing after Robot-assisted Transaxillary Total Thyroidectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.1.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Mohammad S, Hussain A. Outcomes of conjunctival-Müller's muscle resection surgery with and without epinephrine in local anesthetic. Orbit 2020; 41:84-88. [PMID: 33153357 DOI: 10.1080/01676830.2020.1841808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To determine the effect of epinephrine as an anesthetic adjunct on outcomes of conjunctival-Müller's muscle resection (CMMR) ptosis surgery.Methods: A retrospective cohort study of patients having undergone CMMR with plain local anesthetic (LA) and local anesthetic combined with epinephrine (LA+Epi). Two measures of success were investigated: margin to reflex distance 1 (MRD1) success and overall success. MRD1 success was defined as a postoperative MRD1 between 2-4 mm. Overall success was defined as all of i) MRD1 success, ii) a ≤ 1 mm difference between the eyelid height following the preoperative phenylephrine test and post-operative MRD1 (PE-MRD1 Δ), and iii) symmetrical postoperative contour between both upper eyelids. Study inclusion criteria included blepharoptosis from levator aponeurotic dehiscence and satisfactory response to the phenylephrine test. Exclusion criteria included congenital ptosis, ptosis secondary to another cause, previous ipsilateral eyelid surgery, or a medical condition that may have impacted surgery.Results: There were 26 eyelids in the LA+Epi group, and 19 eyelids in the LA group. There was no difference in the two groups in age (P =0.28), pre-operative MRD1 (P =0.37), levator function (P =0.27), intraoperative tissue resection amount (P =0.27), number of weeks postoperatively at final MRD1 measurement (P =0.99), and PE-MRD1 Δ (P =0.08). All patients achieved a symmetrical post-operative eyelid contour. The LA+Epi group had a higher attainment of MRD1 success (P =0.04) and overall success (P =0.045).Conclusions: Epinephrine as an anesthetic adjunct improves CMMR outcome. This suggests its use can be considered the standard of care.
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Affiliation(s)
- Syed Mohammad
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
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Tuncer I, Bilgin S, Zengin MÖ, Mangan MS, Karaca A, Doğan C, Çınar E. Effect of brimonidine tartrate 0.15% on scotopic pupil size and upper eyelid position: controlled trial. Eye (Lond) 2020; 35:672-675. [PMID: 32518394 DOI: 10.1038/s41433-020-1007-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To evaluate the effect of brimonidine tartrate 0.15% ophthalmic solution on pupil size under scotopic condition and upper eyelid position. METHODS This study comprised 72 eyes of 36 healthy subjects. A single drop of brimonidine tartrate 0.15% ophthalmic solution was instilled in the right eye and artificial tear was instilled in the left eye. Pupil size was measured using an infra-red pupillometer under scotopic condition before and at 30 min, 2, 4, 6, 8 and 10 h after instillation. Measurement of margin reflex distance 1 (MRD1) was performed using a millimetre ruler before and after at 10 min after instillation. RESULTS The mean age of the subjects was 32.19 ± 11.43 years (range 10-52 years), 17 were female and 19 were male. Before brimonidine instillation, the mean pupil size was 6.09 ± 1.03 mm in the brimonidine eyes and 6.06 ± 1.04 mm in the control eyes. There was a significant decrease in mean pupil size at 30 min (4.45 ± 1.04), 2 h (4.49 ± 1.06), 4 h (4.59 ± 1.06), 6 h (4.89 ± 1.06) and 8 h (5.38 ± 1.02) after instillation compared to before in brimonidine eyes (p < 0.001 for all). There was a significant miosis continued for at least 6 h (5.95 ± 1.03) in control eyes (p < 0.001). There was no significant change in MRD1, before and after instillation both in brimonidine and control eyes. CONCLUSIONS Brimonidine tartrate 0.15% had a significant miosis under scotopic condition for at least 8 h after instillation and had a significant miosis on the untreated eye for at least 6 h.
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Affiliation(s)
| | | | | | | | | | - Cezmi Doğan
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Distribution of Adrenergic Receptor Subtypes and Responses to Topical 0.5% Apraclonidine in Patients With Blepharoptosis. Ophthalmic Plast Reconstr Surg 2019; 34:547-551. [PMID: 29634605 DOI: 10.1097/iop.0000000000001095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the relationship between the distribution of adrenergic receptors in the human eyelid and the eyelid elevation after topically instilling 0.5% apraclonidine in blepharoptosis patients. METHODS A total of 26 blepharoptotic patients (30 eyelids) were included in the experimental study. Marginal reflex distance 1 was measured before and after topical instillation of 0.5% apraclonidine. Eyelids were divided into 2 groups according to the responses to topical 0.5% apraclonidine. Patients who positively responded to apraclonidine were classified as group A and those that negatively responded to it were classified as group B. Müller's muscle was obtained during the blepharoptotic surgery, followed by immunohistochemical staining and scoring. This study was approved by the Institutional Review Board of Kim's Eye Hospital and the study protocol adhered to the tenets of the Declaration of Helsinki. RESULTS α-1D staining intensity was significantly higher in group A than in B (p < 0.001) and α-2C and β-1 staining intensities were significantly higher in group B than in A (p < 0.001 and p < 0.05, respectively). The difference in β-2 staining intensity between groups A and B was not statistically significant. CONCLUSIONS α-1D adrenoceptor was predominant in patients showing a positive response to topical 0.5% apraclonidine. Because apraclonidine has an α-1 agonistic effect, α-1D adrenoceptor may contribute to apraclonidine's elevating effect in patients with blepharoptosis.
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Wijemanne S, Vijayakumar D, Jankovic J. Apraclonidine in the treatment of ptosis. J Neurol Sci 2017; 376:129-132. [PMID: 28431598 DOI: 10.1016/j.jns.2017.03.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022]
Abstract
Transient ptosis is a known complication of botulinum toxin (BoNT) injection due to inadvertent migration of toxin into the levator palpebrae superioris muscle. Currently there is no treatment available for BoNT induced ptosis. Apraclonidine hydrochloride is a topical ophthalmic solution with selective alpha-2 and weak alpha-1 receptor agonist activity that has the ability to elevate the eye lid. Apraclonidine has been used as a diagnostic test in Horner's syndrome. We evaluated the effects apraclonidine in a cohort of BoNT induced ptosis and a patient with Horner syndrome. Each patient was administered 2 drops of apraclonidine 0.5% solution to the eye with the ptosis and was re-examined 20-30min later. All 6 patients showed improvement in ptosis. There was also improvement in ptosis in a patient with Horner's syndrome. Apraclonidine is not only useful as a diagnostic test in Horner's syndrome, but may be an effective and safe treatment for BoNT-induced ptosis.
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Affiliation(s)
- Subhashie Wijemanne
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA
| | - Dhanya Vijayakumar
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA.
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Lee SJ, Jeon HS, Choi HY. Clinical Feature of Unilateral Ptosis with Positive Result in Phenylephrine Test. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.11.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seok Jae Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Hye Shin Jeon
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
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Kikuchi-Utsumi K, Ishizaka M, Matsumura N, Nakaki T. Alpha(1A)-adrenergic control of piloerection and palpebral fissure width in rats. Auton Neurosci 2013; 179:148-50. [PMID: 23701912 DOI: 10.1016/j.autneu.2013.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/26/2022]
Abstract
We determined the receptor subtypes of α1-adrenoceptor, which is involved in autonomic functions induced by methamphetamine (METH) in rats. An intraperitoneal injection of METH provoked the autonomic responses piloerection, eyelid retraction, and ejaculation. Pretreatment with prazosin, a nonselective α1-adrenoceptor antagonist, completely abolished the above METH-induced responses. Prazosin also provoked eyelid ptosis in saline controls. The effects of prazosin were mimicked only by a selective α1A-adrenoceptor antagonist, silodosin, not by selective α1B or α1D antagonists. These results suggest that α1A-adrenoceptor participates in the regulation of piloerection, palpebral fissure width, and ejaculation in rats.
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Cruz AAV, Ribeiro SFT, Garcia DM, Akaishi PM, Pinto CT. Graves Upper Eyelid Retraction. Surv Ophthalmol 2013; 58:63-76. [PMID: 23217588 DOI: 10.1016/j.survophthal.2012.02.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 02/09/2012] [Accepted: 02/14/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Antonio Augusto Velasco Cruz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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Waqar S, Simcock P. Lower lid entropion secondary to treatment with alpha-1a receptor antagonist: a case report. J Med Case Rep 2010; 4:77. [PMID: 20196844 PMCID: PMC2838915 DOI: 10.1186/1752-1947-4-77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 03/02/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The use of alpha-1a receptor antagonists (tamsulosin) is widely accepted in the treatment of benign prostatic hypertrophy (BPH). It has previously been implicated as a causative agent in intra-operative floppy iris syndrome due to its effects on the smooth muscle. We report a case of lower lid entropion that may be related to a patient commencing treatment of tamsulosin. CASE PRESENTATION A 74-year-old Caucasian man was started on alpha 1-a receptor antagonist (Tamsulosin) treatment for benign prostatic hypertrophy. Eight days later, he presented to the ophthalmology unit with a right lower lid entropion which was successfully treated surgically with a Weiss procedure. CONCLUSION We report a case of lower lid entropion that may be secondary to the recent use of an alpha-1a blocker (tamsulosin). This can be explained by considering the effect of autonomic blockade on alpha-1 receptors in the Muller's muscle on a patient that may already have an anatomical predisposition to entropion formation due to a further reduction in muscle tone.
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Affiliation(s)
- Salman Waqar
- West of England Eye Unit, Royal Devon and Exeter NHS Hospital, Barrack Road, Exeter, Devon, EX2 5DS, UK.
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Use of 0.5% Apraclonidine Solution in Evaluation of Blepharoptosis. Ophthalmic Plast Reconstr Surg 2008; 24:299-301. [DOI: 10.1097/iop.0b013e31817f526a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ayala E, Gálvez C, González-Candial M, Medel R. Predictability of conjunctival-Müellerectomy for blepharoptosis repair. Orbit 2007; 26:217-221. [PMID: 18097957 DOI: 10.1080/01676830601169205] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To assess the predictability of the algorithm used to determine the amount of tissue resection for conjunctival-Müellerectomy during blepharoptosis repair. METHODS A consecutive case series of all patients undergoing conjunctival-Müellerectomy during blepharoptosis repair between July 2001 and February 2005. All of the cases had a positive phenylephrine test, and the mean preoperative upper marginal reflex distance (MRD1) was +1.60 mm (range: -1 +/-3.5 mm). Each patient underwent excision according to the following algorithm: 10 mm of resection for 2 mm of ptosis, 8 mm of resection for 1.5 mm of ptosis, and 6 mm of resection for 1 mm of ptosis. RESULTS Fifty-five patients underwent conjunctival-Müellerectomy during blepharoptosis repair on 73 eyelids, using the above algorithm. Thirty-seven cases were unilateral and 18 were bilateral. The mean postoperative MRD1 was +3.42 mm (range 0-+4.5 mm). Postoperative symmetry was found in 42 of 55 patients (76.4%) after one surgical procedure. Patient satisfaction based on contour, symmetry and height after one repair was achieved in 52 of 55 patients (94.55%). There were three reoperations for previous undercorrection. CONCLUSION This algorithm quantifies conjunctival-Müellerectomy during blepharoptosis repair. Excellent and very predictable results are obtained by a technique that is both simple and achievable in a short operating time.
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Affiliation(s)
- Eva Ayala
- Hospital San Juan de Dios, Santa Cruz, Tenerife, Spain.
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Skibell BC, Harvey JH, Oestreicher JH, Howarth D, Gibbs A, Wegrynowski T, Wing T, Deangelis DD. Adrenergic Receptors in the Ptotic Human Eyelid: Correlation With Phenylephrine Testing and Surgical Success in Ptosis Repair. Ophthalmic Plast Reconstr Surg 2007; 23:367-71. [PMID: 17881986 DOI: 10.1097/iop.0b013e3181462a2e] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between adrenergic receptors in Müller muscle and response to phenylephrine testing in patients undergoing ptosis surgery. This study also compares outcomes of Fasanella and Putterman approaches to posterior ptosis repair. METHODS Prospective analysis of 71 patients undergoing posterior ptosis surgery. Eyelid height was measured before and after phenylephrine. Müller muscle was examined for alpha-1D, alpha-2C, beta-1, and beta-2 receptors. Specimens were graded on receptor staining intensity. Patients were seen 1 week and 6 weeks following surgery. Surgical outcomes were scored on a scale of 1 (most favorable) to 3 (least favorable). RESULTS Adrenergic receptors were found in decreasing order: alpha-1D, beta-1, alpha-2C, and beta-2. Receptor grade significantly predicted eyelid height for alpha-2C receptors (p = .03). Mean outcome scores for 36 Putterman (1.10) and 35 Fasanella (1.27) procedures were not significantly different. CONCLUSIONS Alpha 1D, alpha-2C, and beta-2 receptors are documented within human Müller muscle. Human eyelid elevation response to phenylephrine is inversely related to the amount of alpha-2C receptor staining in Müller muscle. Fasanella and Putterman procedures have equal outcomes, independent of adrenergic receptors.
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MESH Headings
- Adolescent
- Adrenergic alpha-Agonists
- Adult
- Aged
- Aged, 80 and over
- Blepharoplasty
- Blepharoptosis/diagnosis
- Blepharoptosis/metabolism
- Blepharoptosis/surgery
- Child
- Eyelids/metabolism
- Female
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Muscle, Smooth/metabolism
- Phenylephrine
- Receptors, Adrenergic/metabolism
- Receptors, Adrenergic, alpha-1/metabolism
- Receptors, Adrenergic, alpha-2/metabolism
- Receptors, Adrenergic, beta-1/metabolism
- Receptors, Adrenergic, beta-2/metabolism
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Affiliation(s)
- Bentley C Skibell
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
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Garibaldi DC, Hindman HB, Grant MP, Iliff NT, Merbs SL. Effect of 0.5% apraclonidine on ptosis in Horner syndrome. Ophthalmic Plast Reconstr Surg 2006; 22:53-5. [PMID: 16418668 DOI: 10.1097/01.iop.0000196322.05586.6a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To demonstrate the effect of apraclonidine on anisocoria and ptosis in Horner syndrome, one drop of 0.5% apraclonidine was instilled in both eyes of 3 patients who presented with acute Horner syndrome, and the effect on ptosis and anisocoria was documented. As reported in the literature, one drop of 0.5% apraclonidine reverses the anisocoria of Horner syndrome. In addition, 0.5% apraclonidine leads to a complete resolution of the ptosis associated with Horner syndrome, a finding reported once in the literature. Apraclonidine is a safe and readily available alternative to cocaine for the diagnosis of Horner syndrome.
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Affiliation(s)
- Daniel C Garibaldi
- Division of Oculoplastics Surgery, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD 21287, USA
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Baldwin HC, Bhagey J, Khooshabeh R. Open Sky M??ller Muscle-Conjunctival Resection in Phenylephrine Test-Negative Blepharoptosis Patients. Ophthalmic Plast Reconstr Surg 2005; 21:276-80. [PMID: 16052140 DOI: 10.1097/01.iop.0000167789.39570.3e] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the efficacy of Müller muscle-conjunctival resection in patients in whom the phenylephrine test was negative. METHODS A non-randomized, prospective clinical trial was conducted on 20 eyelids of 15 consecutive patients with blepharoptosis who showed no change in the upper eyelid margin-reflex distance (MRD1) following instillation of topical phenylephrine. The technique used was open sky Müller muscle-conjunctival resection. RESULTS The mean MRD1 increased by 3.3 mm. No patient required augmentation of the procedure, and all patients had excellent appearance of their skin crease and eyelid contour. No complications arose from the procedure, including no incidence of dry eye symptoms or signs. CONCLUSIONS Müller muscle-conjunctival resection may offer a safe and effective means of treating blepharoptosis despite a negative phenylephrine test.
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Affiliation(s)
- Heather C Baldwin
- Buckinghamshire Hospitals NHS Trust, Stoke Mandeville and Wycombe General Hospitals.
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Abstract
PURPOSE To determine the magnitude of upper eyelid retraction induced by sudden darkness in normal subjects and in patients with Graves upper eyelid retraction before and after treatment with guanethidine drops. METHODS The study comprised 211 control subjects (n=211 eyes) and 45 patients (n=78 eyes) with Graves upper eyelid retraction. The control subjects were divided in four age groups: 0 to 1 year, 2 to 9 years, 0 to 18 years, and 19 to 61 years. Twenty-one patients with Graves upper eyelid retraction (n=39 eyes) used guanethidine drops for 15 days. Palpebral fissure images of subjects were acquired in photopic conditions and in darkness. For both images, the distance between the mid-pupil and upper eyelid margin was measured. RESULTS Darkness induced upper eyelid retraction in all subjects. The increment in the mid-pupil eyelid distance was greater in children. There was no significant difference between the magnitude of eyelid elevation of Graves patients and normal adults. Guanethidine drops did not abolish the eyelid reflex in Graves patients. CONCLUSIONS Darkness provokes upper eyelid retraction in control subjects and in patients with Graves upper eyelid retraction. This effect decreases with age and does not result from sympathetic stimulation of the Muller muscle.
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Affiliation(s)
- Lígia Cristina Viana Neves
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto-SP, São Paulo, Brazil
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Esmaeli B, Harvey JT, Hewlett B. Immunohistochemical evidence for estrogen receptors in meibomian glands. Ophthalmology 2000; 107:180-4. [PMID: 10647739 DOI: 10.1016/s0161-6420(99)00040-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To look for sex hormone receptor distribution in three structures contributing to the normal human tear film: the conjunctiva, the accessory lacrimal glands, and the meibomian glands. DESIGN An immunohistochemical study. TISSUES AND CONTROLS: Forty-one upper eyelid specimens were collected from 15 male and 26 female patients (age range, 1.5-85 years) during blepharoptosis surgery via posterior tarsoconjunctival mullerectomy (Fasanella-Servat or Gavaris). In addition, control sections of histologically normal breast, prostate, and skin tissue were obtained. METHODS Immunohistochemical staining using mouse monoclonal antibodies against estrogen, progesterone, and androgen receptors was performed on all tissues and controls. Quantitation of the receptors was performed and expressed as percentage nuclear positivity. Specimens were divided into three groups based on the age of the patient: <12 years (n = 9); 18-55 years (n = 1); >55 years (n = 12). RESULTS Forty-one specimens contained conjunctiva. All were negative for estrogen, progesterone, and androgen receptors. Twenty-four specimens contained accessory lacrimal glands of Wolfring. All were negative for the three receptors. Twenty-two specimens contained meibomian glands. All were positive for estrogen receptors; one was positive for progesterone receptors and one for androgen receptors. Using Minitab statistical software (Minitab Inc. State College, PA), analysis of variation revealed no statistical difference between sexes or between age groups studied. The sebaceous glands of skin were uniformly positive for androgen receptors. Sebaceous glands of the face and scalp (3 of the 15 skin samples) were also positive for estrogen receptors. CONCLUSIONS Estrogen receptors are present in the meibomian glands of the upper eyelid. Unlike sebaceous glands elsewhere on the skin, the meibomian glands lack androgen receptors. Estrogen receptors may play a role in modulation of the lipid layer of the tear film, and their activity may be linked to meibomian gland dysfunction and dry eye syndrome.
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Affiliation(s)
- B Esmaeli
- Ophthalmology Section, M D Anderson Cancer Center, Houston, Texas, USA
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