DIGITAL IMAGE-PROCESSING MEASUREMENT OF THE UPPER EYELID CONTOUR IN GRAVES-DISEASE AND CONGENITAL BLEPHAROPTOSIS

Objective: This study used image processing techniques to quantify the upper eyelid contour of patients with Graves upper eyelid retraction and congenital blepharoptosis. Design: The study design was a cross-se ctional study. Participants: A total of 29 patients with Graves diseas e, 22 patients with congenital blepharoptosis, and 50 patients with no history of eye disease participated. Intervention: The images of the palpebral fissure of all participants were transferred to a personal c omputer and processed with NIH Image 1.55 software. Main Outcome Measu res: The following parameters were analyzed: the curvature of the uppe r eyelid contour, the position of the contour peak relative to the mid line, and the ratio between the temporal and nasal upper quadrant area s of the palpebral fissure. Results: All upper eyelid contours could b e fitted with second-degree polynomial functions. The mean temporal/ n asal area ratio was 1.33 mm in patients with Graves disease, 0.92 mm i n patients with blepharoptosis, and 1.04 mm in control subjects. The p eak of the upper eyelid contour was found to be lateral to the midline in control subjects (1.05 mm) and in patients with Graves disease (2. 09 mm). In patients with blepharoptosis, the peak was 0.69 mm medial t o the midline. Overall, the distance between the midpupil and the uppe r eyelid margin was correlated with several factors: the degree of cur vature, the position of the peak of the eyelid contour, and the tempor al/nasal area ratio. Conclusions: In Graves eyelid retraction, the cur vature of the upper eyelid is enhanced, the peak of the contour is dis placed laterally, and the temporal upper quadrant area is increased. C onversely, in congenital blepharoptosis, the eyelid is almost flat, th e peak of the contour is displaced medially, and the upper quadrant ar ea is diminished. The lateral segment of the upper eyelid is more invo lved than the nasal segment in both Graves upper eyelid retraction and congenital blepharoptosis.