title: Contour Symmetry of the Upper Eyelid Following Bilateral Conjunctival-Müller's Muscle Resection.
abstract: Conjunctiva-Müller muscle resection (CMMR) is a simple, effective, and predictable procedure for internal treatment of ptosis.
  
  
  
  The authors determined contour symmetry of the upper eyelid following bilateral CMMR.
  
  
  
  Thirty control participants (ie, without ptosis) and 44 patients with acquired bilateral blepharoptosis who underwent CMMR were evaluated in a prospective study. To assess symmetry of lid contour, distances from midpupil to the upper eyelid (ie, MPLDs) were determined radially at intervals of 15° (total, 180°) along the palpebral fissure, and MPLDs at each angle were compared for right and left eyes.
  
  
  
  For control participants, the mean marginal reflex distance (MRD1; ie, MPLD at 90°) ± standard error (SE) was 4.05 mm ± 0.75 mm, and small contour asymmetries (<10%) were measured for all angles. Medial (9.4% ± 4.7%) and lateral (8.1% ± 4.9 %) asymmetries were not significantly different for these participants. For patients with ptosis, the mean preoperative MRD1 was 2.56 ± 0.1 mm, and mean medial and lateral lid asymmetries (14.3% ± 8.4% and 16.7% ± 9.7%, respectively) were significantly higher than those of controls. Medial and lateral asymmetries correlated significantly with the extent of ptosis and were more pronounced laterally than medially. One month after CMMR, the lateral-medial discrepancy in lid asymmetry was resolved, and mean medial and lateral MPLDs (9.9% ± 7.5% and 8.5% ± 5.3%, respectively) were similar to those of controls.
  
  
  
  For patients with involutional ptosis, CMMR enables elevation of the lid margin and correction of contour anomalies.
authors.affiliation: Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , São Paulo , Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Golbert
authors.affiliation: Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , São Paulo , Brazil.
authors.forename: Filipe Jose
authors.initials: FJ
authors.lastname: Pereira
authors.affiliation: Departamento de Farmacologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Denny M
authors.initials: DM
authors.lastname: Garcia
authors.affiliation: Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo , São Paulo , Brazil.
authors.forename: Antonio A V
authors.initials: AAV
authors.lastname: Cruz
mesh_terms: D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods; D001763:Blepharoptosis / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery*; D005143:Eyelids / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies