External examination
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 01:12
The external examination includes examination of the eyelids, eyebrows, and midface. The eyelid measurements are first performed. The margin reflex distance is the distance between the upper eyelid margin and the corneal light reflex indicating the center of the pupil. The palpebral fissure height is the distance between the upper eyelid margin and the lower eyelid margin. These measurements are all performed with a millimeter ruler and the Finoff transilluminator. The levator function is the excursion of the upper eyelid from downgaze to upgaze with the eyebrow immobilized. The lid crease distance is the distance between the upper eyelid margin and the eyelid crease, which is 8 mm in this case. The lower eyelids are then examined. The patient is instructed to look up and the laxity of the lids is determined by pulling down on the eyelids. The laxity of the upper eyelids is also examined. The position of the brows is determined in relation to the position of the superior orbital rim. Lastly, the midface is examined with regards to prominence or hypoplasia.
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December 19, 2016
