Figure 1.
Parameters used in this study. A: Natural open eyes. B: Wide-open eyes.
MRD1: margin-to-corneal light reflex distance. A DUES-like appearance: a deepening of the upper eyelid sulcus-like appearance.
Table 1.
Patient demographics and measured MRD.
Table 2.
Interobserver agreement regarding the five signs.
Figure 2.
A younger subject judged to have a DUES-like appearance.
A healthy 28-year-old male with a DUES-like appearance of the left eye. An UES was judged to be present when he had natural open eyes. All other signs were judged to be negative.
Figure 3.
An older subject judged to have a DUES-like appearance.
A healthy 72-year-old female with a DUES-like appearance of the left eye. An UES was judged to be present when she had natural open eyes, while other signs were judged to be negative.
Figure 4.
A patient with blepharoptosis judged to have a DUES-like appearance.
A 79-year-old female with blepharoptosis of the left eye. A DUES-like appearance, UES and wrinkles on the forehead were all judged to be positive.
Table 3.
Prevalence of the five signs among the three groups.
Table 4.
Results of the univariate and multivariate logistic regression analyses of the independent predictors of a DUES-like appearance.
Table 5.
Incidence of a DUES like-appearance according to predictive factors.
Figure 5.
A schematic drawing of the upper eyelid and a possible mechanism underlying the presence of a DUES-like appearance.
a. A schematic drawing of the upper eyelid associated with natural open eyes. b. A schematic drawing of the upper eyelid associated with wide-open eyes. A DUES-like appearance occurs when LA draws OS and fat toward the back of the eyeball. LPS: levator palpebrae superioris muscle, WL: Whitnall ligament, OF: orbital fat, OS: orbital septum, AL: anterior layer of LA, PL: posterior layer of LA, FA: fibroadipose layer, OCM: orbicularis oculi muscle, ROOF: retro-orbicularis oculi fat; SR: superior rectus muscle. The black arrow indicates the DUES-like appearance. The red dotted arrows show the effects of the LPS and LA.