Phenylephrine Response in Upper Eyelid Ptosis
Photographer: Audrey C. Ko, MD
Posted July 31, 2018
In patients with mild to moderate upper eyelid ptosis, phenylephrine eyedrops are used to assess whether ptosis correction is achievable with a Müller's muscle-conjunctival resection (MMCR). As an alpha-adrenergic agonist, phenylephrine stimulates the sympathetically innervated Müller's muscle when applied topically. The resulting smooth muscle contraction predicts the potential eyelid lift possible with an MMCR – usually ≤ 3 mm.1 It is estimated that 73 – 78% of patients presenting with ptosis will respond desirably to phenylephrine testing and, thus, will be excellent candidates for MMCR.2, 3 A ptotic upper eyelid that does not sufficiently elevate in response to phenylephrine testing indicates an alternative ptosis correction technique, such as a levator advancement or a frontalis suspension, should be considered.
- Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. Muller's muscle-conjunctival resection for correction of upper eyelid ptosis: relationship between phenylephrine testing and the amount of tissue resected with final eyelid position. Arch Facial Plast Surg 2007;9(6):413-417. https://PubMed.gov/18025352. DOI: 10.1001/archfaci.9.6.413
- Barsegian A, Botwinick A, Reddy HS. The Phenylephrine Test Revisited. Ophthalmic Plast Reconstr Surg 2018;34(2):151-154. https://PubMed.gov/28353471. DOI: 10.1097/iop.0000000000000903
- Grace Lee N, Lin LW, Mehta S, Freitag SK. Response to phenylephrine testing in upper eyelids with ptosis. Digit J Ophthalmol 2015;21(3):1-12. https://PubMed.gov/27330465. DOI: 10.5693/djo.01.2015.05.001
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