Detection of contralateral eyelid retraction associated with blepharoptosis

The association between induced contralateral upper eyelid retraction and blepharoptosis, although well known, has not been well analyzed. The authors prospectively studied 50 consecutive patients with blepharoptosis. Interpalpebral fissure measurements of the contralateral "normal" or relatively less blepharoptotic eyelids were made in the resting position, with the blepharoptotic eye occluded, manually elevated, and after instillation of phenylephrine 2.5%. Ocular dominance also was tested. Contralateral interpalpebral fissure height decreased greater than or equal to 1 mm in 10 of 50 patients (20%) after manual elevation. Blepharoptosis was present or greater in the dominant eye in 7 of 10 (70%) patients in this group, but in only 7 of 40 (18%) patients in the group not showing such a response (P less than 0.001). Of 12 patients with congenital blepharoptosis, none demonstrated this response. In patients with acquired blepharoptosis, contralateral decrease in eyelid position also was directly associated with severity of blepharoptosis in the opposite eye. These findings suggest that contralateral induced eyelid elevation or retraction is frequently associated with blepharoptosis and is more apparent as visual impairment secondary to blepharoptosis increases. Detection of contralateral eyelid retraction is important in the preoperative evaluation of blepharoptosis.