title: Quantitative Comparison of the Effect of 10% Phenylephrine Instillation and Manual Elevation in Patients with Involutional Blepharoptosis.
abstract: OBJECTIVE
  To compare the effect of 10% phenylephrine (PE) instillation and manual elevation (ME) on the upper eyelid position of the tested eye and the contralateral eye in patients with involutional blepharoptosis (IB).
  
  
  METHODS
  IB patients were submitted to two tests followed by observation of the effect on the contralateral eyelid: (1) ME of the more ptotic eyelid; and (2) instillation of two drops of 10% PE (phenylephrine test) in the more ptotic eye. The patients were filmed before and 5, 10, and 15 minutes after instillation. The upper eyelid margin reflex distance (MRD1) was measured using the software Image J, and the results were analyzed with the linear mixed-effects model.
  
  
  RESULTS
  The study included 70 patients aged 44-86 years, 64 of whom were female (91.43%), divided into three groups: subjects with unilateral IB, subjects with bilateral IB, and controls. The eye submitted to instillation with 10% PE displayed significant elevation during the first 10 min: from 1.33 ± 0.66 mm to 2.06 ± 0.89 mm (unilateral group), from 1.26 ± 0.63 mm to 2.29 ± 0.86 mm (bilateral group), and from 3.12 ± 0.68 mm to 4.06 ± 0.92 mm (control group). MRD1 decreased in the contralateral eye in IB patients, significantly more so after the phenylephrine test: PE vs. ME = 18.9% versus 17.2% reduction in the unilateral group, and 13.6% versus 10.7% reduction in the bilateral group. The outcome was not influenced by IB severity and the concurrence of IB and eye dominance.
  
  
  CONCLUSIONS
  Both ME and 10% PE affected the contralateral upper eyelid, but the response was significantly better with the latter.
authors.affiliation: a Department of Ophthalmology , University of São Paulo , São Paulo , Brazil.
authors.forename: Ivana Cardoso
authors.initials: IC
authors.lastname: Pereira
authors.affiliation: a Department of Ophthalmology , University of São Paulo , São Paulo , Brazil.
authors.forename: Suzana
authors.initials: S
authors.lastname: Matayoshi
mesh_terms: D058646:Adrenergic alpha-1 Receptor Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005143:Eyelids; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D010656:Phenylephrine / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D058646:Adrenergic alpha-1 Receptor Agonists; D009883:Ophthalmic Solutions; D010656:Phenylephrine
keywords: Blepharoptosis; MRD1; eyelid; manual elevation; phenylephrine