Upper eyelid motility in blepharoptosis and in the aging eyelid

PURPOSE. TO Study the metrics of lid saccades in blepharoptosis and to dist inguish any differences in the dynamics of eyelid movements that are relate d to the cause of blepharoptosis and to aging. METHODS. The lid and vertical eye saccades of 7 patients with congenital bl epharoptosis and those of 18 patients with aponeurogenic blepharoptosis, ei ther involutional or rigid-contactlens-induced, were recorded with electrom agnetic search coils. For each saccade, two parameters were assessed: ampli tude and peak velocity. Two age-matched control groups were assessed in the same manner. Repeated measures analysis of variance was used to investigat e any observed differences between the included groups. RESULTS. Congenital and rigid-contact-lens-induced blepharoptosis were read ily distinguishable from one another, as well as from the age-matched contr ol group, in both lid saccadic amplitude and peak velocity. For example, 40 degrees downward lid saccades in the congenital blepharoptosis group avera ged 22.9 degrees +/- 4.0 degrees (SD), whereas 30.0 degrees +/- 4.7 degrees lid saccades were made by the age-matched control group. The subjects in t he two groups with aponeurogenic blepharoptosis also made lid saccades that were distinctive for their group (P < 0.02), in both amplitude and peak ve locity. For 40<degrees> downward saccades in involutional and rigid-contact -lens-induced blepharoptosis, lid saccadic amplitude averaged 32.7 degrees +/- 4.3 degrees and 40.3 degrees +/- 3.5 degrees, respectively. Lid saccadi c peak velocity declined significantly with age. Lid saccadic peak velocity for 40 degrees upward saccades in the younger control group averaged 401.7 +/- 11.4 deg/sec, whereas the older control group achieved an average peak velocity of 360.7 +/- 60.4 deg/sec. The lid saccadic dynamics in the invol utional blepharoptosis group proved to be similar (P > 0.05) in saccadic am plitude and peak velocity to these of age-matched controls. CONCLUSIONS. In different forms of blepharoptosis, distinctive metrics of L id saccades occur. The current data suggest that involutional blepharoptosi s is not a consequence of normal age-related changes in eyelid function.