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The phenylephrine test effectively elevates ptotic eyelids, with most responses occurring within 10 minutes. However, some patients show delayed eyelid elevation, and patient characteristics do not predict response.

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Area of Science:

  • Ophthalmology
  • Oculoplastics

Background:

  • Involutional ptosis is a common condition affecting eyelid position.
  • The phenylephrine test is used to assess potential eyelid elevation in ptotic patients.

Purpose of the Study:

  • To characterize the phenylephrine test in patients with ptosis.
  • To improve the efficiency of performing the phenylephrine test for clinicians.

Main Methods:

  • Digital photographs assessed eyelid response to topical 2.5% phenylephrine in 24 adults (30 eyes) with involutional ptosis.
  • Recorded patient characteristics, change in marginal reflex distance-1 (MRD-1), conjunctival blanching, pupillary dilation, and Hering effect.
  • Correlations between characteristics and outcomes were evaluated.

Main Results:

  • 73% of eyes showed eyelid elevation with phenylephrine.
  • Most responses (86%) peaked by 10 minutes, but 14% were delayed up to 30 minutes.
  • Greater baseline ptosis correlated with more significant phenylephrine-induced elevation; no patient factors predicted response.

Conclusions:

  • Most ptotic eyelids respond to phenylephrine within 10 minutes, but a subset shows delayed elevation.
  • Eyelid elevation magnitude is greater in more ptotic eyelids.
  • Pupillary dilation and conjunctival blanching do not predict eyelid elevation response.