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Eyelid Dynamics and Supratarsal Crease Appearance After Double Eyelid Surgery
Abstract
Background:
Although double eyelid surgery is one of the most common cosmetic surgeries among Asians, there are few reports to confirm the physiology of eye blinking after such surgeries. This study analyzed eyelid dynamics and supratarsal crease appearance after double eyelid surgery using a high-speed digital camera to provide precise movement detection.
Methods:
Twenty healthy volunteers and 15 patients who underwent double eyelid surgery with tarsodermal fixation were studied. Using the slow-motion replay setting of a high-speed digital camera, the patients' spontaneous eye blinking was analyzed for (1) blink duration, (2) peak eyelid velocity, (3) blink rate, and (4) supratarsal crease appearance.
Results:
After double eyelid surgery, there were no significant differences in blink duration, peak eyelid velocity, or blink rate compared with the control group. Regarding supratarsal crease appearance, dynamic creases were created in 6 of 15 patients, whereas 9 patients showed static creases.
Conclusions:
Double eyelid surgery with tarsodermal fixation does not alter lid dynamics of spontaneous eye blinking. Furthermore, the tarsodermal fixation method, which is known to create a static crease, could also lead to the development of a dynamic crease.
... This procedure also helps to soften the pronounced orbital lid crease, thereby making the lower double eyelid crease more defined and prominent. As a result, the overall appearance of the eyes becomes sharper and more alert (Figure 1) [19]. ...
... This procedure also helps to soften the pronounced orbital lid crease, thereby making the lower double eyelid crease more defined and prominent. As a result, the overall appearance of the eyes becomes sharper and more alert ( Figure 1) [19]. ...
Supraorbital hollowness and pretarsal fullness, commonly known as the sunken eyelid and charming roll, respectively, are significant anatomical features that impact the aesthetic appearance of the periorbital region. Supraorbital hollowness is characterized by a recessed appearance of the upper eyelid, often attributed to genetic factors, aging, or surgical alterations, such as excessive fat removal during blepharoplasty. This condition is particularly prevalent among East Asians due to anatomical differences, such as weaker levator muscles and unique fat distribution patterns. Pretarsal fullness, also known as aegyo-sal, enhances the youthful and expressive appearance of the lower eyelid, forming a roll above the lash line that is considered aesthetically desirable in East Asian culture. Anatomical-based filler injection techniques are critical for correcting these features, involving precise placement within the correct tissue planes to avoid complications and achieve natural-looking results. This approach not only improves the aesthetic appeal of the eyelid but also enhances the overall facial harmony, emphasizing the importance of tailored procedures based on individual anatomy and cultural preferences.
... 11 However, the mechanisms behind the development of DED after blepharoplasty remain unclear. Potential causes, such as impairment of lacrimation, increased evaporation due to lagophthalmos, and lipid deficiency in the tear layers resulting from insufficient meibomian gland secretion due to incapacitated blinking, are thought to play a role in the development of postsurgical DED. 14 Thus, studies evaluating blink rate and speed by videographic methods, [15][16][17] noninvasive tear breakup time (NI-TBUT), 10,12 and tear lipid layer thickness after blepharoplasty have already been published in the literature. 13 Especially tear film instability is considered the key mechanism. ...
... Although not exclusively studied, the literature suggests that a decrease in meibomian gland secretion due to insufficient and weak blinking may cause the development of DED after eyelid surgeries. 29 However, in videographic studies evaluating the blink reflex after upper eyelid blepharoplasty, no significant change was observed in the blink reflex despite muscle removal, [15][16][17] suggesting that the blink reflex alterations are not the mechanism underlying postoperative DED. 16 Furthermore, Wan et al. 30 reported no change in meibum secretion in the postoperative first week of patients with insufficient blink reflex due to facial paralysis, with a decrease over 3 months. ...
Purpose:
To evaluate the early- and long-term effects of 2 different blepharoplasty techniques on corneal nerves, meibomian gland morphology, clinical parameters of dry eye disease (DED), and eyebrow position.
Methods:
This prospective, interventional study included age-sex-matched blepharoplasty patients who had a skin-only resection (24 eyes of 12 patients; Group-S) or a skin-plus-orbicularis muscle resection (24 eyes of 12 patients; Group-M) procedure. Preoperative and postoperative parameters of in vivo corneal confocal microscopy (IVCCM; corneal nerve fiber density [CNFD], nerve branch density [CNBD], and nerve fiber length), meibomian gland area loss (MGAL), DED (Schirmer I test and noninvasive tear breakup time), and eyebrow heights (lateral [LBH] and central [CBH]) were evaluated and compared between the intervention groups (ClinicalTrials.gov, NCT05528016).
Results:
Compared with baseline, the CNBD of Group-S (19.91 ± 7.66 vs. 16.05 ± 7.28 branches/mm2, p = 0.049) and CNFD of Group-M (19.52 ± 7.45 vs. 16.80 ± 6.95 fibers/mm2, p = 0.028) was significantly decreased at postoperative first week. However, in both groups, IVCCM parameters returned to baseline values at postoperative first month and first year (p > 0.05). A significant MGAL increase was observed in Group-S (18.47 ± 5.43 vs. 19.94 ± 5.31, p = 0.030) and Group-M (18.86 ± 7.06 vs. 20.12 ± 7.01, p = 0.023) at the postoperative first year, demonstrating meibomian gland atrophy. Only significant changes were observed in Group-M in LBH (16.17 ± 2.45 vs. 16.67 ± 2.28 mm, p = 0.044) and CBH (17.33 ± 2.35 vs. 17.96 ± 2.31 mm, p = 0.004) at postoperative first year.
Conclusions:
Blepharoplasty with or without orbicularis resection seems to have similar effects on IVCCM, DED, and MGAL parameters. However, incorporating an orbicularis muscle resection in a blepharoplasty operation could slightly elevate the eyebrow position.
... High-speed cameras have recently been used in the analysis of an eyelid blink. [18][19][20][21][22][23] In the present study, spontaneous blinks were recorded for each patient using a 240-frame-per-second high-speed digital camera with 512 · 384-pixel resolution (Casio EXILIM EX-100F, Casio Computer, Co., Ltd., Tokyo, Japan). Time resolution of 240 frames per second has been determined to be sufficient to capture blink dynamics. ...
Background: Brow-lift-induced eyelid closure impairment is commonly discussed in patients with facial paralysis but has not been well quantified. Objective: To measure the limitation of eyelid closure in patients with facial paralysis using simulated brow-lift with tape. Design, Setting, and Participants: For 50 facial paralysis patients with brow ptosis who visited our institution from October 2017 to December 2020, brow-lift was simulated by elevating the paralyzed-side brow using surgical tape, and closed palpebral fissure heights in spontaneous blinking were measured using high-speed videography. The effect of several factors on the change in closed palpebral fissure height was evaluated by multiple linear regression analysis. Results: Greater patient age (p = 0.021), single eyelids (p = 0.003), higher value of closed palpebral fissure height before simulation (p = 0.004), and higher value of brow elevation (p = 0.013) were significant for the increase of closed palpebral fissure height. Conclusions: Brow elevation to the degree that achieves symmetrical brow height could be detrimental to eyelid closure in patients with facial paralysis, especially who are elderly, have single eyelids, or present with preoperative decreased lid-closure function. UMIN Clinical Trials (UMIN Registry No. 000042974).
... High-speed cameras have recently been used in the analysis of eyelid blink. [12][13][14][15][16][17] In the present study, spontaneous blinks were recorded for each patient with a 240-frame-per-second high-speed digital camera with 512 Â 384-pixel resolution (Casio EXILIM EX-100F, Casio Computer, Co., Ltd., Tokyo, Japan). Time resolution of 240 frames per second has been known to be sufficient to capture blink dynamics. ...
Background:
Static eyelid reconstruction surgery, such as ptosis repair or brow lift, is widely performed for patients with facial paralysis. Complications include exposure keratitis and possible vision loss mainly due to eyelid closure impairment in spontaneous blinking. However, no quantitative evaluation data has been available regarding postoperative closure deterioration.
Methods:
To elucidate factors associated with postoperative eyelid closure impairment, a retrospective study was performed for 51 patients who underwent an initial static eyelid reconstruction surgery from October 2017 to August 2020. A static eyelid reconstruction surgery consisted of either 1 or more of the following: (1) levator advancement, (2) brow lift, and (3) orbicularis oculi myectomy. Eyelid closure ratios (0% for complete closure impairment and 100% for perfect closure) at spontaneous blinks were measured on 6 occasions: before operation and at postoperative 1, 3, 6, 9, and 12 months. Comparison was made between preoperative and postoperative values by using mixed-effects model.
Results:
Overall, average closure ratio was significantly increased. However, 10 patients had >10% closure ratio decreases at at least 1 postoperative measurement point, and all those patients had undergone brow lift procedures.
Conclusions:
Although eyelid closure at spontaneous blinks may, contrary to assumptions, generally be improved after static eyelid reconstruction surgery, brow lift was suggested to be associated with eyelid closure impairment.
... The ultimate aim of blepharoplasty is to create a natural double-eyelid configuration. The characteristics of ''inborn double eyelid (IDE)'' include [1]: (1) The upper eyelid skin is smooth without obvious scar or tension; (2) the crease that is movable and not sticking to tarsus emerges and fades dynamically along with blinking [2]; (3) the pre-septal and pre-tarsal skins are flat without a step-like feature; (4) the pre-tarsal skin is movable and moves up a little lag behind the tarsus. The mechanism of blepharoplasty is to connect palpebral skin to the up-lifting power system, so to create a palpebral furrow. ...
Background
Double-eyelid blepharoplasty is one of the most popular aesthetic surgeries in China. But the traditional method produces a hidebound double eyelid due to its rigid suturing between the skin and the tarsus. The authors of this article concluded a novel technique of “flexible suspension technique” compared with traditional blepharoplasty which is considered as a “rigid fixation technique.”
Methods
This is a retrospective study of two groups of 100 Chinese Han females, on whom double-eyelid blepharoplasty was performed, 50 cases by “flexible suspension technique” and the other 50 by “rigid fixation technique.” The basic procedure of “flexible suspension technique” is suturing the orbicularis oculi muscle to the septal extension. Thus, the surgical connection between skin and tarsus is flexible. The surgical results were evaluated and compared using the Global Aesthetic Improvement Scale and Visual Analogue Scale/Score.
Results
The “very much improved” rate in the “flexible suspension technique” group was higher than that in the “rigid fixation technique” group (p < 0.05). Postoperative appearances of the “flexible suspension technique” group were also better than the “rigid fixation technique” group with less edema (p < 0.05) and slighter incision scars (p < 0.05). However, the incidences of asymmetry and fold loss were higher in the “flexible suspension technique” group (p < 0.05).
Conclusion
The flexible suspension technique blepharoplasty can obtain a more natural appearance and has less adverse effects and shorter recovery time.
Level of Evidence IV
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This study presents a novel technique to measure the motion of the eyelid during blinking. High-speed imaging and digital image correlation (DIC) were employed to monitor the eyelid during blinking in a noninvasive manner. Both spontaneous and reflex blinks were studied. A black liquid eyeliner was used to generate a speckle pattern on the surface of the eyelid. Facet motion captured through a DIC analysis software generated kinematic data for each blink. Calculations using this dataset yielded information on the duration of the blink, eyelid displacements, and peak eyelid velocities. A consistent dataset quantified the difference between blink types and reinforced the repeatability of this DIC analysis method to measure the kinematics of blinking.
Purpose:
To report initial results using a native 240 frames per second smartphone camera for 2-dimensional videographic analysis of eyelid dynamics during spontaneous blinking.
Methods:
Spontaneous blinking was prospectively recorded in volunteers using a smartphone camera recording at 240 frames per second in 720p. A standardized recording setup was used in which the smartphone was mounted on a tripod stand at 0.5 m in the Frankfort horizontal plane. Subjects viewed a nature documentary video in primary gaze while their spontaneous blinking was recorded for 3 minutes. Exclusion criteria included known eyelid malposition or ocular surface pathology, including dry eye syndrome, contact lens use, prior eyelid or intraocular surgery, prior periocular trauma, or craniofacial abnormality. Primary outcome measures were spontaneous interblink interval, blink rate in blinks per minute, percentage of incomplete blinks, and blink velocity.
Results:
The authors studied 10 subjects, 5 men and 5 women. Average age was 34 (range 19-58). Mean interblink interval was found to be 7.4 seconds (SD: 5.2, range: 1.9-17.6), corresponding to a mean blink rate of 13 blinks per minute (SD: 7.8, range: 3.4-32.0). Mean percentage of incomplete blinks was 49.8% (SD: 33.3, range: 0-100). Mean blink closure velocity was 93 mm/seconds (SD: 31, range: 40-160). These numbers are consistent with previously published results of spontaneous eyelid blink parameters.
Conclusions:
This study demonstrates that 240 frames per second videography native to modern smartphone cameras captures anatomic detail and blink dynamics with sufficient resolution and clarity to provide objective clinical information about spontaneous eyelid blink rate, dynamics, and function.
Blink is a complex phenomenon that is profoundly affected by diverse endogenous and exogenous stimuli. It has been studied in the context of cognition, emotional, and psychological states, as an indicator of fatigue and sleepiness, particularly in the automobile and transportation industry, in visual tasking, and finally, as it relates to tear film stability and ocular surface health. The fact that it is highly variable and has input from so many sources makes it very difficult to study. In the present review, the behavior of blink in many of these systems is discussed, ultimately returning in each instance to a discussion of how these factors affect blink in the context of dry eyes. Blink is important to ocular surface health and to an individual’s optimal functioning and quality of life. Disturbances in blink, as cause or effect, result in a breakdown of tear film stability, optical clarity, and visual function.
Purpose: To measure spontaneous blink metrics and brow motion in patients with congenital ptosis operated with frontalis slings with autogenous fascia lata.
Methods: An infrared three-dimensional video motion analyzer was employed to simultaneously measure brow motion and spontaneous blinks of 17 patients with congenital ptosis who underwent frontalis sling with autogenous fascia lata and a control group of equal number of healthy subjects. A customized software identified and quantified the amplitude and maximum velocity spontaneous blinks eyelid and brown motion during a 5-minute observation of a commercial movie. The corneal status of the patients with and without lagophthamos was evaluated with slit-lamp biomicroscopy with fluorescein staining.
Results: Lagophthalmos was detected on 13 (76.5%) patients. Out of these 3 (23%) showed signs of inferior superficial keratopathy despite the presence of normal (upwards) Bell’s phenomenon in all of them. Blink rate was significantly diminished in the patients. The distribution of interblink time was similar in both groups. The mean amplitude of the down-phase of the patients’ blinks was only 38% of the controls. The main sequence slope of the patients’ blinks was abnormally low. In controls brow motion was a minute and random event no related to blinks. In the patients, the mean brow amplitude was five times higher than in controls reaching 45% of the blink amplitude.
Conclusions: Spontaneous blink amplitude and velocity are severely impaired in patients with fascia lata autogenous slings. After surgery blinking amplitude is linearly related to the amplitude of brow motion.
This study provides a comprehensive description of upper eyelid movement in normal human subjects. Using the magnetic search coil technique to monitor lid position and modified skin electrodes to record orbicularis oculi electromyographic (EMG) activity, the authors found that the basic eyelid movements, blinks, and saccadic lid movements, can be uniquely and reliably characterized by their amplitude-maximum velocity relationships. The data show that similar increases in levator palpebrae activity produce the upward lid movements that accompany upward saccadic eye movements as well as the upward phase of a blink. The lid movements that accompany downward saccadic eye movements arise almost exclusively from the passive downward forces and relaxation of the levator palpebrae muscle. In contrast, active orbicularis oculi contraction and the passive downward forces act together to generate lid closure with a blink. These normative data and techniques provide the basis for the clinical analysis of lid motility by which abnormal lid movements can be compared with normal lid kinematics.
This new edition is unique in its exclusive focus on all aspects of Asian blepharoplasty. You'll gain in-depth knowledge and essential understanding of anatomical differences and corresponding techniques for people of varying age and ethnic groups. Thoroughly updated, state-of-the-art coverage spans the latest procedures...from preoperative preparation through operative techniques, outcomes, and postoperative instructions. Step-by-step descriptions of every procedure, lavishly illustrated with full-color photographs and completely redrawn line drawings, provide helpful guidance to help you achieve superior, consistent surgical results. Plus, receive a Bonus DVD-ROM with 20 detailed clinical cases covering both primary and revisional techniques, narrated by Dr. Chen. Presents concise, practical information in an easy-to-use formatideal for use in the office and OR. Clarifies the terminology associated with Asian blepharoplasty. Provides step-by-step descriptions of the author's practice-proven surgical techniques. Clearly explains the anatomy that is essential to the performance of surgical procedures. Comprehensive spread-sheets listing all significant literature references in the last 100 years. Discusses common and rare instances of suboptimal results and their revision. Bonus DVD-ROMwith 20 detailed clinical cases, 12 covering primary and 8 covering revisional techniques, narrated by Dr. Chen. View full cases or clips of specific techniques performed on different patients. Includes intraoperative video clips on aBonus DVDthat features 20 detailed, step-by-step clinical cases performed and narrated by Dr. Chen for both primary and revisional techniques! Features a wealth of new and expanded coverage on such topics as anesthesia * ethnic variance * suture ligation methods * wound closure * and triangular, trapezoidal, and rectangular debulking of preaponeurotic eyelid tissues. Illustrates cases as they present in practice, with over 340 full-color photographs and 70 updated line drawings. Offers experts' hints, tips, pearls, and pitfalls on the complexities of aesthetic oculoplastic surgery.
Spontaneous blinking is essential for maintaining a healthy ocular surface and clarity of vision. The spontaneous blink rate (SBR) is believed to reflect a complex interaction between peripheral influences mediated by the eye surface and the central dopaminergic activity. The SBR is thus extremely variable and dependent on a variety of psychological and medical conditions. Many different methods have been employed to measure the SBR and the upper eyelid kinematics during a blink movement. Each has its own merits and drawbacks, and the choice of a specific method should be tailored to the specific needs of the investigation. Although the sequence of muscle events that leads to a blink has been fully described, knowledge about the neural control of spontaneous blinking activity is not complete. The tear film is dynamically modified between blinks, and abnormalities of the blink rate have an obvious influence on the ocular surface.
Standard approaches for creating a double eyelid in Asian patients may cause hematoma, asymmetry, early release of the fold, or an unsatisfactory appearance.
We report an approach to creating a double eyelid based on integration of the septoaponeurotic union into the dermis of the pretarsal skin.
A preoperative design was drawn with the patient in the supine and sitting positions, with the fold level always located 8 to 10 mm from the lid margin. An incision was made and deepened by removal of a narrow strip of the orbicularis muscle until the anterior orbital septum was identified. The entire length of the anterior orbital septum was opened, and a dissection was performed along the avascular plane between the orbital fat and the posterior orbital septum. The septoaponeurotic union was sutured to the lower edge of the incised pretarsal dermis. The levels of the double-fold line were checked with the patient in the supine and sitting positions.
Results in a series of 610 patients treated between March 1996 and March 1999 were satisfactory. Complications included a 2% rate of diminution of the double fold occurring in patients treated early in the series, probably caused by loose sutures between the septoaponeurotic union and the lower edge of the incised pretarsal skin. In 10 patients, the fold line was asymmetric or too high. All patients with complications were treated successfully by reoperation with use of the same technique.
Creation of a double eyelid through attachment of the septoaponeurotic union to the pretarsal dermis can provide a secure double eyelid with a more aesthetic appearance. (Aesthetic Surg J 2002;22:154-161.).
In the Oriental lid, the levator aponeurosis, which is contiguous with the orbital septum, is only loosely adherent to the muscle inferiorly and not at all fixed to the tarsus. It would seem that a more secure attachment of the skin along the proposed sulcus can be attained by attaching it directly to the tarsus which is elevated by the levator in concert with Muller's muscle. This results in a reliable, well defined sulcus that is dynamically produced when the lid is elevated.
• For good cosmesis the upper eyelid creases and folds must be symmetric. The lid creases must be the same height above the upper lid margins. The skin below the crease must be smooth and firmly attached to the tarsus, or, in cases with a short tarsus, adherent to the short tarsus and levator muscle up to the crease. The skin above the crease must be loosely attached so that it forms symmetric folds over the crease.
We have developed surgical procedures aimed at the following: (1) equalizing the upper lid creases and folds where they are asymmetric, (2) creating lid creases and folds where absent, as in Orientals, (3) removing excess unsightly skin folds, as in dermatochalasis, and (4) forming a lid fold by skin grafting where there is insufficient skin above the crease.
Photographic and video analyses show that the primary position of the eyes is a natural constant position in alert normal humans, and the eyes are automatically saccadically reset to this position from any displacement of the visual line. The primary position is not dependent on fixation, the fusion reflex, gravity, or the head position. The primary position is defined anatomically by head and eye planes and lines that are localized by photography, magnetic resonance imaging, and x-rays of the head and neck. The eyes are in the primary position when the principal (horizontal) retinal plane is coplanar with the transverse visual head (brain) plane (TVHP), and the equatorial plane of the eye is coplanar with a fixed orbital plane (Listing's plane). Evidence is presented to indicate an active neurologic basis for the primary position instead of passive mechanical forces. A different understanding of the primary position and the conception of the TVHP may be valuable in analyzing oculomotor defects.
Among the considerations in the formation of the double eyelid, two factors are considered to be important. They are the levator insertion into the skin and the amount of soft tissue between the levator aponeurosis and the skin. The author assumes that the amount of soft tissue may be more importantly related to forming the double eyelid than the levator expansion. Based on this assumption, the author undertook a modified operation to create the double eyelid by removing excessive soft tissue without any fixation to the levator aponeurosis or the tarsal plate.
The oriental eyelid operation was modified and applied to selected caucasians to achieve a better esthetic result in upper lid blepharoplasty.
The endogenous eyeblink is identified as a cortically controlled response event, distinguishable from both reflexive and voluntary lid movements. It has a characteristic rate, form, and temporal distribution. These aspects of endogenous blinks are related to cognitive state variables. Allocation of attentional resources, transition points in information processing flow, and possibly processing mode, are indexed by blink parameters.
Conventionally, it has been argued that the aponeurosis meets the orbital septum below the upper tarsal border in Orientals. However, we have shown that the aponeurosis fused with the orbital septum above the upper tarsal border in 502 patients, which contradicts the classic concept. In 457 patients there were distinct layers of fascia anterior to the orbital septum that originate from the septum and insert onto the pretarsal aponeurotic expansion. In Oriental eyelids, the preaponeurotic fat and orbital septum hang below the fusion line of the septum and aponeurosis. The hanging portion of the septum was dissected from the aponeurosis, plicated, and sutured to the dermis of the pretarsal flap. We performed the septodermal fixation technique in 512 patients over 3 years starting in March of 1992. Complications and changes of the folds were analyzed. The technique produced much less edema and discomfort and created more natural fold lines than any other technique. Patients were very lightly satisfied with the shape of the folds that we were able to design and adjust precisely with this method.
Previous assessments of spontaneous eyeblink frequency (SEBF) or interblink intervals (IBI) have been made over period of 0.5 to 15 min and average values calculated; the reliability of the methods has not been validated. Video recordings were made of 14 healthy volunteers, aged 20 to 38 years, while silently fixating on a 2 m distant, 35 mm high target under 350 lux illumination and the traces assessed with an event marker. Significant fluctuations in SEBF or IBI were generally observed, but which did not conform to a minute-by-minute periodicity. Time-dependent trends were uncommon, although uncritical pooling or averaging of data can effectively conceal such fluctuations or trends. Correlation's between SEBF and IBI indicate that eyeblink monitoring over at least 3 min is required. Simple averaging calculations are not appropriate because of a high chance of non-Gaussian distribution of data. Modal IBI values correlated well with an adjusted modal calculated SEBF which is thus recommended for further use.
One of the characteristic features of the East Asian person's eyelids is the lack of a supratarsal fold. A relaxed upper eyelid skin, due to the lack of supratarsal fixation, causes coverage of the tarsal margin of the upper eyelid. Thus the palpebral fissure looks smaller, giving a slit-eye appearance. Unlike those lids with a natural supratarsal crease, the levator palpebrae muscle and/or aponeurosis does not extend and attach to the pretarsal skin. The purpose of the double-eyelid operation is to create a supratarsal fold in the eyelids of Asian patients. Numerous surgical procedures have been developed to establish adherence between the levator aponeurosis and the eyelid skin. There are 2 main goals for this procedure: (1) a smooth, tight skin below the newly created supratarsal crease and (2) firm fixation between the levator aponeurosis and the skin to prevent relapse to a single eyelid. Most procedures described rely on loose cicatrization between the skin and the levator aponeurosis.
This is a preliminary report of plastic reconstruction of the superior palpebral fold in nine women and one man for aesthetic purposes. As far as I know, this is the first attempt locally to form a superior palpebral fold to enhance the physical appearance of those born with foldless eyelids.
To investigate the dynamics of ocular eyelid movements in newborn infants and preschool-age children.
Fifty newborn infants and 200 preschool children aged 4-6 years were examined. Images of each child, with his or her eyes in the primary eye position looking at an object placed at the child's height, were recorded with a digital videocamera for 3 mins. Complete and incomplete blink rates, opening, closing and complete blink times were calculated.
Newborn infants presented a lower number of incomplete movements than preschool children. The complete blink rate was lower in newborn infants (6.2 blinks/min) than in preschool children (8.0 blinks/minute). Eyelid closing, opening and compete blink times were longer in newborn infants than in preschool children at all observation times.
Newborn infants had a different pattern of eyelid movement compared with preschool children. Specific characteristics that are found in this group of children particularly, such as immaturity of the neural system and more resistant tear film, may explain these findings in part.
For the economical recording of eye movements using the scleral search-coil method, we developed a circuit using common components and costing only $300. The Helmholtz field coils are 51 cm in diameter and are separated by 51 cm. The horizontal and vertical field coils are driven at 50 and 75 kHz, respectively, by phase-locked square waves; no tuning is required. After amplification, the eye-coil signal is phase detected at 50 and at 75 kHz to produce the horizontal and vertical eye-position signals, respectively. For a 2 cm diameter eye coil of one turn, the noise is 1.0 min of angle rms.
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