Definition Angle of slant of the palpebral fissure from the horizontal (Fig. 7.48).
Landmarks A comparison between two lines is necessary. One line connects the inner canthus and outer canthus of the eye. The second line is defined by the Frankfort horizontal (FH), a line connecting the lowest point on the lower margin of each orbit, identified by palpation (the orbitale), and the highest point on the upper margin of the cutaneous
external auditory meatus (the porion) The slant of the palpebral fissure is the angle between the two lines (Fig. 7.48).
Instruments A commercial angle-meter, protractor, or goniometer is a useful instrument for this measurement. One edge is placed along the FH; the other straight side follows the line between the commissures of each eye.
Position The standard orientation of the head is the FH. The subject may be recumbent, in which case the FH becomes vertical.
Alternative A rough angle meter or protractor can easily be made on firm transparent material such as X-ray film. A horizontal line on this device is aligned with the FH in the patient and the angle of obliquity of the palpe-bral fissure is read according to the position of the outer canthus. A rough estimate of this horizontal can be made by joining a line between the two inner canthi and extending this laterally; however, the FH is more accurate.
Remarks This is a particularly difficult measurement unless the patient can be kept perfectly still. Palpebral fissure inclinations for ages 6-18 years are shown in Fig. 7.49.
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