Contents
A drooping eyelid (ptosis) is a condition in which the upper eyelid is not positioned correctly, when it partially or completely closes the eye. This condition is characterized by a low position of the upper eyelid, eye irritation, and its rapid fatigue. In order for a person to see normally, he needs to tilt his head back, which contributes to strabismus and diplopia. As diagnostic measures, the measurement of the height of the upper eyelid, the symmetrical arrangement of the eyes and their mobility are used. Therapy of such a deviation is carried out only by surgical intervention.
In a healthy person, the iris of the eye overlaps only 1,5 millimeters.
But ptosis appears when the overlap exceeds 2 millimeters, or when the omission is too visually noticeable.
This condition may be congenital or acquired.
A drooping eyelid is not just a visual problem. It does not allow the visual analyzer to develop and work normally, because there is a mechanical obstruction of visibility.
To eliminate such a defect, you need to contact an ophthalmologist and a plastic surgeon.
Ptosis classification
Omission can be bilateral, as well as unilateral. The latter is diagnosed in 70% of cases. It can also be true and false. False ptosis occurs when there is a large amount of skin and subcutaneous fat. In addition, a hernia of the upper eyelid, strabismus, low elasticity of the eye can lead to this. These pathologies almost always provoke bilateral omission. The only exception is unilateral endocrine eye disease.
Another omission is physiological and pathological. Physiological deviation is due to the emotional state of a person, that is, surprise, fatigue, anger, reaction to pain and many other factors. In this case, the omission will be bilateral and short-lived.
Pathological omission occurs when the eye is traumatized or during inflammation of the eye muscle that moves the eyelid. It can also happen with inflammation of the meninges, with lesions of the conductive nervous system, after a stroke, and in the presence of neoplasms in the brain.
There are also various states of the disease that manifest themselves at different degrees of development:
- First degree (partial ptosis). The pupil overlaps by ⅓.
- Second degree (incomplete ptosis). Half of the pupil or ⅔ overlaps.
- Third degree (complete ptosis). Complete closure of the pupil.
Based on the cause of the pathology, it is divided into congenital and acquired.
Congenital omission of the eyelid is revealed:
- With congenital Horner’s syndrome. In addition to the omission of the eyelid, it is also manifested by the narrowing of the pupil, weak sweating on one side of the face, retraction and deepening of the eyeball.
- With Marcus-Gunn syndrome. The drooping of the eyelid disappears if the mouth is completely open, as well as when chewing, yawning, shifting the jaw to the side.
- With Duane’s syndrome. This is a rare form of congenital strabismus where the eye cannot be turned outward.
- Isolated ptosis. This is a genetic congenital deviation that manifests itself from two sides.
Acquired drooping of the eyelid occurs mainly on one side. Appears after traumatic injuries, due to a person’s age, neoplasms and various pathologies that led to levator paralysis or paresis. Acquired ptosis has its own distinctive forms of development:
- Aponeurotic. This omission is due to age-related changes in the human body, when dystrophic changes and weakness of the eye muscles occur. In rare cases, this is affected by an injury or long-term corticosteroid therapy.
- Myogenic. Appears with myasthenic syndrome, muscle dystrophy and after myopathies of the eye.
- Neurogenic. It develops after damage to the nerve of the eye, which is responsible for its movement, as well as with its aplasia, paresis, multiple sclerosis, stroke and much more. Eyelid prolapse, which is associated with damage to the oculomotor nerve, is always accompanied by a dilated pupil and a violation of the movement of the eyeball. Also, the nerve may not transmit an impulse to the muscle after Botox is injected into the frontal muscle. She relaxes too much, because of which the skin fold begins to hang.
- Mechanical. It happens with inflammation and swelling, scars, eye diseases. For example, with tumors and lesions.
- Drop after blepharoplasty. It may appear as one of the above forms or be a combination of several. It is a consequence of inflammatory edema after surgery, during damage to the eye muscles and the formation of hematomas, and also due to the formation of coarse adhesions.
Causes of omission
The eyelid opens with a special muscle called the levator that controls the oculomotor nerve. From this it follows that the main reason for the drooping of the eyelid can be called anomalies of this muscle or changes in the oculomotor nerve.
With congenital omission, the levator may be poorly developed or it will not exist at all. Sometimes there is aplasia of the conducting pathways or nuclei. The congenital species is a genetic pathology. But this can happen due to the pathological course of pregnancy and during labor. Often, a birth defect is accompanied by other eye diseases and abnormalities.
Symptoms of pathology
The drooping of the upper eyelid happens on one side or affects both at once, while the degree of manifestation is also different. The eye is covered partially or completely. Patients with such a pathology should strain the forehead muscle, raise their eyebrows or tilt their head back – in this way, patients see better. The latter is called the astrologer pose. When the upper eyelid is lowered, it is difficult for a person to blink his eyes. Because of this, the eyes quickly get tired, the person becomes irritable, sometimes infection of the eyes occurs.
Congenital omission manifests itself in parallel with strabismus. With constant overlapping of the eye with the eyelid, the patient also develops amblyopia. But for the acquired, other concomitant diseases are characteristic: diplopia and a violation of the sensitivity of the cornea.
Due to the fact that there are many reasons for the appearance of drooping of the upper eyelid, a differential study of the patient is carried out to treat the defect. Several specialists deal with these problems – an ophthalmologist, a neurologist, a plastic surgeon.
Diagnosis of eyelid prolapse
As already mentioned, with such a defect, differential diagnosis and examination by several specialists should be carried out.
At the first appointment, the doctor will conduct a visual examination. During the physical examination, the parameters of the damaged eye will be determined. In addition, other functional indicators should be identified.
For this, the patient is prescribed special ophthalmological tests, for example:
- perimetry, biomicroscopy – to find out the visual acuity of the patient
- the angle of strabismus is measured – exophthalmometry;
- the amount of accommodation is set;
- study convergence;
- conduct a study of binocular vision.
With mechanical drooping of the eyelid, a plain x-ray of the orbit is taken to establish the presence or absence of damage to the bone near the eye muscle.
If there is an assumption about the presence of a pathology of a neurogenic nature that affected the drooping of the eyelid, the patient is prescribed:
- magnetic resonance or computed tomography of the brain;
- consultation with a neurologist;
- examination by a neurosurgeon.
Defect treatment
Initially, eyelid drooping therapy is carried out in order to eliminate the very cause that influenced it, and then the cosmetic defect is corrected.
With the neurogenic nature of eyelid drooping, the main cause is also treated first, and then, as an addition, local physiotherapy is used: paraffin therapy, galvanization, UHF.
Congenital omission of the eyelid, or in the case when conservative treatment has not yielded the expected results after 9 months, ophthalmic surgery is performed. It is possible to quickly eliminate a congenital defect at certain periods of life. If the eyelid partially covers the pupil, then the operation is performed at the age of 13 to 16 years. With complete closure of the eye due to the fact that amblyopia may develop, the patient is operated on at preschool age.
The operation to eliminate this defect is aimed at shortening the length of the eye muscle, which is responsible for lifting the eyelid. This procedure is used for congenital pathology. To eliminate the acquired omission of the eyelid, the levator aponeurosis is shortened.
In congenital pathology, a levator is isolated, plication is performed, excising the muscle, or a duplication is created. With a pronounced omission of the muscle responsible for raising the eyelid, it is sutured to the frontal muscle.
In the course of a standard surgical intervention to eliminate an acquired defect, a small area of the upper eyelid is excised. In addition, a resection of the aponeurosis is performed, and its lower edge is fixed to the cartilage of the eyelid.
During eyelid surgery, upper blepharoplasty is performed in parallel.
After the surgical intervention, swelling appears. To reduce it slightly, it is necessary to do cool compresses during the first day after the intervention. It can be a dry, but cold towel, or any dry freeze. With each passing day, the swelling will subside, and the eyelid will become its usual appearance and color. All this will take about fourteen days. After that, the person will be able to go back to their usual activities and work.
However, after the operation, not only swelling may appear, the eyelid may not close completely. Until everything returns to normal, the mucous membrane of the eye must be constantly moistened. To do this, use special drops and ointments. They must be prescribed by the attending physician after the operation.
Treatment prognosis
The functional and visual result of the correction of the drooping eyelid, if the method of surgical treatment was chosen correctly, will remain forever.
If the prolapse is due to ophthalmoplegia, then the prescribed therapy will only partially remove this defect. Surgical intervention for myogenic disorders, which appeared as a result of myasthenia gravis, will not give a positive result.
If you do not carry out any treatment for a drooping eyelid, then after a while a person develops amblyopia, a decrease in vision.