Digital image analysis to characterize the upper lid marginal peak after levator aponeurosis repair

Ophthalmic Plast Reconstr Surg. 2011 Jan-Feb;27(1):12-4. doi: 10.1097/IOP.0b013e3181eea2e3.


Purpose: Lid contour is important for eyelid symmetry, but clinical quantification can be difficult. The marginal peak is a major determinant of upper eyelid contour, and its horizontal position, relative to the mid-pupillary line, may be used as a measure of symmetry after surgery. This study used digital image analysis to assess the peak position in patients who had undergone levator aponeurosis repair.

Methods: An unselected group of patients underwent anterior-approach levator aponeurosis repair, performed under local anesthesia by a single surgeon, using 3 6/0 Vicryl sutures to reattach the levator aponeurosis to the upper tarsus. Both before and 2-3 weeks after ptosis repair, digital photographs were taken in a fixed format and the images analyzed using NIH imaging software to assess the position of the upper eyelid peak. Comparisons were made between the pre- and postoperative measurements in the operated eye and between the operated eye and its fellow eye.

Results: Twenty people (8 male; 40%) underwent unilateral levator muscle resection (9 right eyes; 45%). In eyes before ptosis surgery, the peak was significantly more medially placed (median +0.17 mm) as compared with that of fellow eyes (median +0.80 mm) (p = 0.023). There was a significant temporal shift of the median peak after surgery, from +0.17 mm to +0.92 mm (p = 0.029). Although there was a minor nasal shift of peak in the unoperated eyes after contralateral surgery (median +0.80 mm to +0.64 mm), the peak positions for the 2 eyes were not significantly different at 2-3 weeks after aponeurosis repair (p = 0.22).

Conclusions: Digital image analysis allows an objective assessment of the upper eyelid marginal contour after ptosis repair. A nasal shift in the upper eyelid marginal peak has been identified in ptotic eyes (as compared with the contralateral side) and, after successful ptosis repair, there is a significant temporal shift to match the unoperated fellow eye.

MeSH terms

  • Anesthesia, Local
  • Blepharoplasty
  • Blepharoptosis / diagnosis*
  • Blepharoptosis / surgery
  • Eyelids / pathology*
  • Eyelids / surgery
  • Female
  • Humans
  • Image Processing, Computer-Assisted*
  • Male
  • Oculomotor Muscles / pathology*
  • Oculomotor Muscles / surgery
  • Photography
  • Reproducibility of Results
  • Suture Techniques*