Eyelid Movement Disorders Clinical Trial
Official title:
Müller's Muscle as a New Proprioceptive Organ Evidence From Immunohistochemical Staining and Electron Microscopy to Verify That the Upper Eyelid Müller's Muscle Contains Proprioceptive Innervation for Reflexive Correction of Eyelid Position
Objectives: Upper eyelid retraction was believed to be maintained solely by voluntary
contraction of the levator palpebrae superioris (LPS) and frontalis muscles, together with
involuntary contraction of the sympathetically innervated Müller's muscle (MM). However,
several studies have suggested that the LPS also undergoes involuntary contractions, and that
a visual stimulus may not be the only trigger for frontalis muscle contractions. Recent
studies hypothesized that the MM contains proprioceptive neuronal structures, which elicit
involuntary LPS muscle contraction by the mesencephalic trigeminal nucleus via a continuous
stretch reflex. We aim to identify proprioceptive structures in MM by means of histological
examinations.
Methodology: Prospective study. Collaboration of oculoplastics, ophthalmologists and a
neuroanatomy specialist in Sheba Medical Center. 50 fresh MM specimens from patients
undergoing Müllerectomies will undergo histologic examinations, including immunohistochemical
staining and light and electron microscopy.
Significance: Identification of proprioceptive structures in MM will be the first
evidence-based proof of a proprioceptive mechanism in the eyelid. This might have a
significant impact on future surgical management of eyelid procedures. Comprehensive
understanding of the mechanisms underlying eyelid function is especially important in the
management of children with ptosis who may have coexisting amblyopia.
The investigators' goal is to find proprioceptive neuronal structures in Müller's muscle (MM). The investigatorswill recruit 50 MM specimens of patients diagnosed with either unilateral or bilateral ptosis who were referred to undergo a posterior approach surgical correction (MMCR). In this surgical approach, the proximal part of MM is removed between the levator palpebrae superioris muscle and the tarsus of the upper eyelids. The excised tissue is generally not used but simply discarded. For study purposed, the investigators will obtain the patients' consent to save these tissues and carry out histologic examinations of the samples. No change in the surgical procedure or the following management will be needed. ;
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