Cross-sectional study of the association between a deepening of the upper eyelid sulcus-like appearance and wide-open eyes

PLoS One. 2014 Apr 29;9(4):e96249. doi: 10.1371/journal.pone.0096249. eCollection 2014.


Background: Deepening of the upper eyelid sulcus (DUES) is a common complication of prostaglandin F2α analog treatment, which causes cosmetic problems. However, identifying this condition using photographs is difficult due to such problems as the camera flash effects, blepharoptosis or wide-open eyes.

Purpose: We investigated the association between a DUES-like appearance and wide-open eyes regarding the presence of wide-open eyes as a cause for overestimating the incidence of DUES.

Subjects and methods: One eye and the forehead in 100 subjects (31 younger subjects, 30 older subjects and 39 patients with blepharoptosis) were evaluated in the present study. Digital photographs of the subjects with natural open and wide-open eyes were taken with a flash. Five signs (a puffy eyelid, the presence/absence of the upper eyelid sulcus (UES), wrinkles on the forehead with natural open eyes and an increase in the number of wrinkles on the forehead and a DUES-like appearance with wide-open eyes) were judged to be negative or positive by three independent observers. Univariate and multivariate logistic regression analyses were performed to determine the independent predictor(s) of a DUES-like appearance with wide-open eyes.

Results: Fourteen subjects (four young, three old and seven subjects with blepharoptosis) were judged to have a DUES-like appearance with wide-open eyes (14%). The only predictive factor was the presence of UES in the patients with natural open eyes (odds ratio = 17.244, 95% confidence interval: 3.447-86.270, P<0.001). Among the 12 UES-positive subjects, six (50%) exhibited a DUES-like appearance with wide-open eyes.

Conclusions: The presence of wide-open eyes can thus cause a DUES-like appearance. Blepharoptosis itself is not a predictive factor; however, care should be taken not to overestimate the incidence of DUES, especially in patients with UES with natural open eyes, as a DUES-like appearance can be caused by wide-open eyes, even in treatment-naïve patients.

Trial registration: UMIN000010500.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blepharoptosis / pathology*
  • Cross-Sectional Studies
  • Dinoprost / analogs & derivatives
  • Eyelids / drug effects
  • Eyelids / pathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prostaglandins F, Synthetic / adverse effects
  • Young Adult


  • Prostaglandins F, Synthetic
  • Dinoprost

Grant support

The authors have no support or funding to report.