title: Digital image processing measurement of the upper eyelid contour in Graves disease and congenital blepharoptosis.
abstract: OBJECTIVE
  This study used image processing techniques to quantify the upper eyelid contour of patients with Graves upper eyelid retraction and congenital blepharoptosis.
  
  
  METHODS
  The study design was a cross-sectional study.
  
  
  METHODS
  A total of 29 patients with Graves disease, 22 patients with congenital blepharoptosis, and 50 patients with no history of eye disease participated.
  
  
  METHODS
  The images of the palpebral fissure of all participants were transferred to a personal computer and processed with NIH Image 1.55 software.
  
  
  METHODS
  The following parameters were analyzed: the curvature of the upper eyelid contour, the position of the contour peak relative to the midline, and the ratio between the temporal and nasal upper quadrant areas of the palpebral fissure.
  
  
  RESULTS
  All upper eyelid contours could be fitted with second-degree polynomial functions. The mean temporal/nasal area ratio was 1.33 mm in patients with Graves disease, 0.92 mm in patients with blepharoptosis, and 1.04 mm in control subjects. The peak 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 to the midline. Overall, the distance between the midpupil and the upper eyelid margin was correlated with several factors: the degree of curvature, the position of the peak of the eyelid contour, and the temporal/nasal area ratio.
  
  
  CONCLUSIONS
  In Graves eyelid retraction, the curvature of the upper eyelid is enhanced, the peak of the contour is displaced laterally, and the temporal upper quadrant area is increased. Conversely, in congenital blepharoptosis, the eyelid is almost flat, the peak of the contour is displaced medially, and the upper quadrant area is diminished. The lateral segment of the upper eyelid is more involved than the nasal segment in both Graves upper eyelid retraction and congenital blepharoptosis.
authors.affiliation: Department of Ophthalmology, University of São Paulo, School of Medicine of Ribeirão Preto, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Cruz
authors.forename: R P
authors.initials: RP
authors.lastname: Coelho
authors.forename: A
authors.initials: A
authors.lastname: Baccega
authors.forename: M C
authors.initials: MC
authors.lastname: Lucchezi
authors.forename: A D
authors.initials: AD
authors.lastname: Souza
authors.forename: E E
authors.initials: EE
authors.lastname: Ruiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000150:complications* / Q000151:congenital*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005143:Eyelids / Q000473:pathology*; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted