Measurement of Upper Eyelid Sulcus Deepening (DUES)
I cannot create visual images or schematics, but I can provide a detailed description of the measurement technique based on the methodology you've outlined and supporting evidence.
Measurement Technique
DUES is measured in side profile by determining the horizontal distance from the inferior extended line of the superior orbital rim to the most sunken point of the upper eyelid. 1
Key Measurement Points
- Reference line: Identify the superior orbital rim and extend an imaginary horizontal line inferiorly 1
- Target point: Locate the most sunken/deepest point of the upper eyelid sulcus 1
- Measurement: Calculate the horizontal distance between these two points in millimeters 1
Grading System
The severity classification is based on the measured horizontal distance 2:
- Mild DUES: < 5 mm horizontal distance
- Moderate DUES: 5-10 mm horizontal distance
- Severe DUES: > 10 mm horizontal distance
Important Technical Considerations
Each eye should be evaluated as a separate sample, as DUES can be asymmetric between eyes. 3, 2
Side profile photography is essential for accurate measurement, as frontal views can be misleading due to wide-open eyes, brow elevation, or flash effects. 1 Research demonstrates that wide-open eyes can create a DUES-like appearance in up to 50% of patients who have a visible upper eyelid sulcus with natural open eyes, leading to overestimation of true DUES 1.
Clinical Context
The presence of a visible upper eyelid sulcus (UES) with natural open eyes is the strongest predictor of a DUES-like appearance (odds ratio 17.244), making careful assessment critical to avoid false-positive diagnoses. 1
DUES has been documented as occurring in 9-14% of patients treated with prostaglandin analogs by 6 months, and represents a significant risk factor for post-surgical blepharoptosis (odds ratio 8.56) after glaucoma filtration surgery 3, 2.