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Levator Function Revisited; A two phase assessment of lid movement to better identify levator - superior rectus synkinesis
  1. Carole Jones1,
  2. Edward Lee1,
  3. John Sparrow2,
  4. Richard Harrad2
  1. 1 Maidstone Hospital, United Kingdom;
  2. 2 Bristol Eye Hospital, United Kingdom
  1. * Corresponding author; email: ophthcaj{at}


Aim: To assess a 2 Phase method of recording levator function in order to facilitate the identification of patients with ptosis and synkinesis between the superior rectus and levator muscles.

Methods: 40 consecutive patients who attended oculoplastic clinics with ptosis and 22 patients with normal lid function were recruited. In each subject levator function was recorded first by the conventional means (measuring total upper eyelid excursion between the extremes of down-gaze and up-gaze). Levator function was then also assessed using our novel 2 Phase approach in which upper eyelid excursion is measured separately between down-gaze and primary position (Phase 1), and between primary position and up-gaze (Phase 2).

Results: In normal patients and most of the patients with ptosis the majority of lid movement and hence levator function occurs between down-gaze and the primary position (Phase1). In those patients with ptosis and levator-superior rectus synkinesis a higher proportion of lid movement occurred on up-gaze (Phase2).

Conclusion: The 2 Phase measurement of lid movement highlights levator function in differing gaze positions and facilitates the identification of those patients with levator superior rectus synkinesis.

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