title: Proprioceptive Phenomenon With Involutional Ptosis: Evidential Findings in Anophthalmic Ptosis.
abstract: OBJECTIVE
  To determine the effect of ptosis on compensatory frontalis contraction in patients without visual input and to identify if a sensory stimulus contributes to brow elevation.
  
  
  METHODS
  A prospective study. Clinical photographs were measured by 2 masked oculoplastic surgeons to determine brow height in 8 patients with unilateral ocular prosthesis in 3 conditions: at baseline, after a gold weight was applied to the upper eyelid inducing acute ptosis, and with the gold weight plus topical anesthetic. The measured brow height was then compared between the 3 scenarios.
  
  
  RESULTS
  Mean brow height increased after application of the gold weight when compared with baseline, and this difference reached significance (p = 0.012). After topical anesthetic was applied, the mean brow height decreased but not back to baseline. When mean brow height during the gold weight with topical anesthesia was compared with baseline and with the gold weight only scenarios, the difference was not significant (p > 0.05).
  
  
  CONCLUSIONS
  Frontalis contraction is observed when acute ptosis is simulated in anophthalmic patients, confirming that a contracted visual field cannot be the only stimulus for compensatory brow elevation. A sensory or proprioceptive mechanism is suggested but not confirmed by the trend of reduction in brow elevation with topical anesthesia.
authors: *New York-Presbyterian Hospital, Weill Cornell Medical Center, Department of Ophthalmology, New York, New York, U.S.A.; and †NYU Langone Medical Center Department of Ophthalmology, Institute of Reconstructive Plastic Surgery, New York, New York, U.S.A.
authors: Kira L
authors: KL
authors: Segal
authors: Gary J
authors: GJ
authors: Lelli
authors: Alina
authors: A
authors: Djougarian
authors: Caroline R
authors: CR
authors: Rosenberg
authors: April J
authors: AJ
authors: McCullough
authors: Richard D
authors: RD
authors: Lisman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000503:physiopathology* / Q000601:surgery; D015353:Eye Enucleation; D017234:Eye Evisceration; D005138:Eyebrows / Q000502:physiology*; D005152:Facial Muscles / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D020273:Orbital Implants; D011434:Proprioception / Q000502:physiology*; D011446:Prospective Studies; D019919:Prosthesis Implantation