J Korean Ophthalmol Soc.  2016 Nov;57(11):1678-1683. 10.3341/jkos.2016.57.11.1678.

Clinical Feature of Unilateral Ptosis with Positive Result in Phenylephrine Test

• Lee SJ
• Jeon HS
• Choi HY

• KMID: 2357721
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1678

Abstract

PURPOSE
To investigate the clinical features and therapeutic effects of unilateral ptosis in patients who respond to the phenylephrine (PE) test.
METHODS
Patients who presented with unilateral ptosis from January 2010 to December 2014 and underwent a PE test were included in the analysis. A 2.5% ophthalmic solution of phenylephrine hydrochloride was instilled at the superior conjunctival fornix in the ptotic eye. After 10 minutes of instillation, the patients' eyelid heights were evaluated. Underlying systemic diseases were examined based on previous medical history, a blood test, neurologic examination, and radiologic imaging findings.
RESULTS
Twenty-six of 44 patients who underwent a PE test showed positive results. Fourteen (53.8%) patients with positive PE test had systemic disease, and 2 (11.2%) patients had systemic disease with negative PE test. In the positive PE test group, the associated systemic disease frequency was remarkably high (p = 0.004). Myasthenia gravis (MG) was found more frequently in the positive PE test group than in the negative PE test group (p = 0.031). After 6 months, the interpalpebral fissure height increased by 2.20 mm in the positive PE test group and 2.38 mm in the negative PE test group. Patients receiving medication treatment experienced an increase in interpalpebral fissure height of 2.00 mm in the positive PE test group and 2.50 mm in the negative PE test group. In patients undergoing observation alone, the interpalpebral fissure height increased by 1.50 mm in the positive PE test group and 0.80 mm in the negative PE test group. There was no significant difference in treatment methods (respectively, p = 0.147, p = 0.228 and p = 0.112).
CONCLUSIONS
The PE test can be considered to help with differential diagnosis when examining patients with mild to moderate ptosis. If the PE test is positive, underlying comorbidity including MG should be considered.

Keyword

Phenylephrine test; Ptosis

MeSH Terms

Comorbidity
Diagnosis, Differential
Eyelids
Hematologic Tests
Humans
Myasthenia Gravis
Neurologic Examination
Phenylephrine*
Therapeutic Uses
Phenylephrine
Therapeutic Uses

Figure

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  Figure 1. Distribution of associated systemic diseases in patients with unilateral ptosis according to phenylephrine test results. (A) Positive, (B) Negative. The systemic disease was associated more frequently in patients with positive results.

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  Figure 2. Distribution of patients according to the management of unilateral ptosis with positive or negative phenylephrine test result. 12 of 26 (46.1%) patients with positive results and 12 of 18 (66.7%) patients with negative results underwent operation. The remaining patients were treated with medication or observed. MMCR = Müller's muscle conjunctival resection.

Reference

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