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Relationship Between Phenylephrine Testing and the Amount of Tissue Resected With Final Eyelid Position

Guy J. Ben Simon, MD; Seongmu Lee, MD; Robert M. Schwarcz, MD; John D. McCann, MD, PhD; Robert A. Goldberg, MD

Arch Facial Plast Surg. 2007;9(6):413-417.

Objectives  To evaluate the outcome of Müller's muscle–conjunctival resection (MMCR) for correction of upper eyelid ptosis and to explore the relationship between phenylephrine testing, muscle resection, and surgical outcome.

Methods  Medical records were reviewed for all patients who underwent MMCR at the Jules Stein Eye Institute, Los Angeles, California, from January 1, 1999, through June 30, 2005. Outcome measures were margin reflex distance-1, ptosis correction after instillation of phenylephrine drops, extent of MMCR, ptosis correction, and eyelid symmetry.

Results  In 80 patients who underwent 131 MMCR procedures for correction of upper eyelid ptosis, margin reflex distance-1 increased on average by 1.6 mm (P < .001). In 106 patients (81%), eyelid symmetry equal to or less than 1 mm was achieved (P = .02). Phenylephrine testing underestimated the extent of ptosis correction achieved with MMCR. A weak correlation was found between the extent of MMCR and ptosis correction (r = 0.2; P = .04).

Conclusions  Müller's muscle–conjunctival resection is effective for ptosis correction in patients with good levator muscle function; good eyelid symmetry is achieved in most patients. Phenylephrine testing underestimated the ptosis correction achieved with MMCR by 40%. The relationship between MMCR and ptosis correction is complex.

Author Affiliations: Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel (Dr Ben Simon); and Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at the University of California–Los Angeles (Drs Lee, Schwarcz, McCann, and Goldberg).

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