The Effect of Hering's Law in Ptosis
Photographer: Audrey C. Ko, MD
Posted June 28, 2018
A 62-year-old woman with a history of glaucoma and bilateral superior trabeculectomies presented with bilateral brow ptosis and right upper eyelid ptosis (Figure 1). The patient underwent bilateral brow ptosis repair by internal browpexy and right upper eyelid ptosis repair by external levator advancement (ELA). After unilateral upper eyelid ptosis repair, the patient developed contralateral ptosis (Figure 2) . The reflexive descent of the contralateral upper eyelid after the unilateral raising of the ptotic eyelid is common and explained by Hering's Law. Surgical repair leads to decreased innervation to the bilateral levator palpebrae muscles, which are equally innervated . The patient subsequently underwent a left upper eyelid ptosis repair by ELA.
- Clark TJE, Klejch WJ, Wang K, Allen RC, Nerad JA, Carter KD, Shriver EM. Hering's Law in Congenital Ptosis: Evaluation of the Contralateral Response to Unilateral Congenital Ptosis Repair. Ophthalmic Plast Reconstr Surg 2018;34(3):284-290. https://PubMed.gov/28723733. DOI: 10.1097/iop.0000000000000951
Worley MW, Gal O, Anderson RL, al Hariri A. Eye dominance and Hering's law effect on bilateral blepharotosis repair. Ophthalmic Plast Reconstr Surg 2013;29(6):437-439. https://PubMed.gov/24192503. DOI: 10.1097/IOP.0b013e31829d02e8
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.