Commentary on: Anthropometry of the eyelid and palpebral fissure in an Indian population.

In their article " Anthropometry of the Eyelid and Palpebral Fissure in an Indian Population, " Dr. Patil et al establish normal periorbital anthropometric values for a population that has not been studied to a great degree in the oculoplastic surgery literature. Their study included 216 male and female patients, 16 to 60 years old. Digital image analysis was prospectively performed to measure the following parameters: • the distance between the medial canthus and the lateral canthus (palpebral fissure width), • the distance between the open upper eyelid margin and the lower eyelid margin (vertical palpe-bral fissure distance), • the intercanthal distance, • the interpupillary distance, and • the height of the open upper lid. In choosing these measurements, the authors investigated parameters consistent with ranges published in current ophthalmic plastic surgery literature. The authors found that the mean intercanthal distance increased with age in both males and females, along with an increase in the palpebral fissure width and the vertical dimension of the upper lid. Upper eyelid height also increased with age among males and females. Interpupillary distance, however , decreased with age. As the authors state, the study's anthropometric eyelid parameters are more consistent with Western rather than Asian eyelid calculations. Nevertheless, the vertical height range in the Indian population is larger than that provided in the current oculoplastic surgery literature (8-10 mm). Furthermore, Indian males tend to have a larger vertical height compared to females, although the authors offer no explanation for the cause of these findings, which are distinct. Upper or lower lid retraction may account for the larger-than-expected vertical height observed in both sexes. For instance, was there a larger incidence of inferior scleral show in this group of patients? Specifically, did the females have a higher incidence of mild upper lid ptosis to account for the vertical difference between the sexes, and/or did the males have a higher incidence of lower lid retraction? The authors also found that the vertical distance increased with age but again offered no explanation. Was there a higher incidence of involutional lower lid retraction or ectropions present in the older-age group that attributed to the observed increase in vertical height? Both upper and lower lid positions can certainly affect vertical height. Future studies could elaborate on the vertical height by evaluating the distance of the upper eyelid from the center of the pupil in primary gaze (referred to as …