Ptosis of the upper eyelid in an infant treatment. Ptosis - types, causes, symptoms, methods of diagnosis and treatment

Ptosis is an abnormal prolapse upper eyelid. In this case, the patient partially or completely closes the palpebral fissure and, accordingly, the field of view. Therefore, ptosis is not only a cosmetic defect, but also a serious ophthalmic disease. Ptosis of the upper eyelid can lead to functional blindness.

Ptosis of the upper eyelid can be acquired or congenital. In children with a congenital form of the disease, ptosis is often combined with strabismus or amblyopia (lazy eye disease).

The treatment of ptosis is predominantly surgical.

Causes of ptosis of the upper eyelid in children

Causes of ptosis include trauma or birth defects that lead to muscle weakness or impaired neuromuscular transmission of the upper eyelid. Cause of ptosis in children early age an injury received by the child during childbirth, a neurofibroma (a tumor of the nerve sheath in the upper eyelid) or a hemangioma (a tumor of the blood vessels) can serve.

Among the causes of ptosis of an asymmetric bilateral slowly progressive form is called myasthenia gravis (an autoimmune neuromuscular disease). Dystrophic myasthenia simultaneously causes poverty of facial expressions and depletion of the temporal muscles.

Ophthalmoparesis, as one of possible causes ptosis in both eyes, leads to a symmetrical form of the disease and weakness of the orbicular muscle of the eyes.

Causes of ptosis of the upper eyelid acute form are usually neurogenic. Eyelid prolapse is often observed in Horner's syndrome (pathology of sympathetic innervation). With this type of pathology, ptosis of the upper eyelid develops in only one eye.

The cause of ptosis of the senile form is age-related changes in the muscles of the eyelid and sagging of the skin that has lost its elasticity over the palpebral fissure.

Whatever the causes of ptosis, patients need to consult an ophthalmologist.

Signs of ptosis of the upper eyelid in children

The main symptom of ptosis is drooping of the eyelid of one or both eyes. A patient with ptosis of the upper eyelid cannot completely close the eye, and this leads to visual fatigue and irritation of the eye tissues.

Patients with ptosis of the upper eyelid also have difficulty blinking. Trying to expand the field of view, they tilt their heads back. Attempting to lift the eyelid with your hands can lead to infection of the patient's eyes. Congenital ptosis in children often occurs against the background of amblyopia or diplopia (double vision).

Diagnosis and treatment of ptosis of the upper eyelid in children

Diagnosis of ptosis is not difficult. To make a diagnosis, the height of the eyelid is measured, the symmetry and completeness of the movement of the upper eyelids of both eyes are checked.

Treatment of ptosis of the upper eyelid is surgical. The standard operation for ptosis is the shortening of the eyelid by forming the so-called levator duplication on it. To do this, three U-shaped sutures are made on the eyelid of a patient in need of ptosis treatment.

This type of ptosis surgery cannot be performed in patients with a congenital form of the disease, since in this case the patient usually has too thin a layer of eyelid muscle mass. Treatment of ptosis of the upper eyelid with the application of duplication of the levator often leads to eruption of the sutures and recurrence of the disease.

An alternative operation for ptosis of the upper eyelid is the technique of forming a duplication of the tarsoorbital fascia. It differs from the above-mentioned method of treating ptosis in the way it strengthens the crease of the eyelid. In addition to three U-shaped sutures, this operation for ptosis involves the use of diathermocoagulation (cauterization of the upper eyelid with diathermic current) of the upper eyelid muscle membrane.

The use of diathermocoagulation in the treatment of upper eyelid ptosis can reduce the trauma of the operation, improve subsequent scarring of the muscles of the eyelid, and dispense with the use of grafts during surgical correction of the pathology.

Surgery with ptosis of the upper eyelid is carried out under local anesthesia. The exception is children: during operations with ptosis in children General anesthesia is recommended.

Congenital ptosis is a disease characterized by drooping of the upper or lower eyelids, it can be unilateral or bilateral, but the former is much more common.

The disease occurs during the period of intrauterine development of the embryo. How to recognize and treat pathology? More on this later.

Classification

Ophthalmologists divide congenital blepharoptosis into 3 types:

partial - upper eyelid closes the pupil by 1.5 mm;
incomplete - the pupil is closed by 2 mm;
full - the pupil is completely closed.

Symptoms

Congenital ptosis is unilateral and bilateral. If the upper eyelid is lowered, then the fold is invisible or absent. When looking down, the pathology is invisible. If the disease is unilateral, then one eyelid is placed above the other due to cicatricial changes in the oculomotor muscle.

If the disease provoked paralysis of the III pair cranial nerves, the disease is manifested by a violation of the mobility of the eye.

The main symptoms of congenital blepharoptosis:

lowered upper eyelid over one or two eyes;
inability to close the eyelids;
limited mobility of the eyelid;
the eyes turn red, there is a feeling of dryness and pain;
the affected eye gets tired quickly;
images of objects are bifurcated;
strabismus;

A newborn with a diagnosis of "unilateral ptosis" may not open his eyes for 3-5 days.

Treatment Methods

Congenital ptosis is treated by two methods: traditional and surgical. Conservative treatment used in rare cases, for example, with neurogenic blepharoptosis. The goal of therapy is to restore function oculomotor nerve.

The traditional methods of treating a congenital form of the disease include UHF therapy - this is a method of physiotherapy, in which high frequencies of the electromagnetic field gently and effectively act on the diseased area. Galvanization (iontophoresis) is modern method treatment, which uses a constant electric current of low voltage (about 80 V) and low power (about 50 mA). Also, a drooping eyelid can be fixed with a special plaster, although this method is not very effective and causes discomfort to the patient.

If traditional methods do not bring positive results needs to be surgical operation. This is the most effective method treatment of the disease. The operation is best performed at a young age, because the older the patient, the higher the risk of postoperative complications.

If the lowered eyelid is motionless, then it is fixed to the forehead cosmetic suture which is almost invisible after the operation. The functionality of this method is doubtful, but you can not be afraid of complications.

If the eyelid is moderately mobile, then the part of the muscle that raises the upper eyelid is removed. After resection, the muscle becomes shorter and the eyelid can no longer fall. To do this, the doctor makes a small incision on the eyelid, cuts off a strip of skin and removes part of the muscle.

If the excursion of the eyelid is good, then muscle duplication is superimposed. The muscle shortens, and the eyelid takes the correct position.

Congenital ptosis obliges you to act quickly and find a professional surgeon who will conduct competent therapy. After all, the further prognosis depends on the results of treatment. An unsuccessful operation can lead to various complications.

For a more complete acquaintance with eye diseases and their treatment, use the convenient search on the site or ask a specialist a question.

Ptosis of the upper eyelid in children is not so common, but it still happens sometimes. If your baby has a drooping eyelid, you should consult a doctor. Most likely, the specialist will advise you to do a surgical operation. This is necessary in order to ensure the normal development of your baby's vision. But folk remedies are powerless here.

How Newborn Vision Works From the moment of birth, babies are able to see some objects and shapes, but their vision is not yet fully developed. They can see faces and large objects, but everything is still very blurry, not distinguishing small details.

Newborns are attracted to bright colors and the contrast of light and shadow, but many are unable to tell the difference between similar shades and other details.

The child's vision develops very quickly. It has been proven that when he reaches the age of three or four months, he is already able to distinguish fine details and many colors.

At the age of four months, the child's eyes should work in pairs so that he can feel the depth of space.

At the age of two, the vision of a baby from the vision of an adult is practically no longer different.

A child with ptosis may appear very sleepy or have one eye that looks smaller than the other. Ptosis can be both on one eye and on two.

A pediatric ophthalmologist will help you finally find out this issue and confirm or refute the diagnosis. The doctor will evaluate the vision, examine the pupils and the ability of the eyes to move. In addition, he measures the height of the eyelid, its rise and the strength of the eye muscle.

If the doctor diagnoses ptosis of the upper eyelid medium degree, there is no need to panic. This is just a cosmetic defect that does not affect vision. Surgical intervention for newborns in this case is not prescribed. It will only be necessary to visit an ophthalmologist regularly to monitor the condition of the eyes. Some correction is possible when the child gets a little older.

There are times when the upper eyelid does not rise enough and blocks vision. Then urgent intervention is necessary, since the child is threatened by various eye diseases (for example, amblyopia).

In addition to vision problems, ptosis of the upper eyelid sometimes causes the child to raise his jaw and tilt his head back in order to see better. This negatively affects the development of his motor skills.

Correction strong degree ptosis usually requires surgery.

If the child's vision is not severely impaired, the operation can be delayed until the moment when the baby is three or five years old. In severe cases, the operation cannot be postponed!

Operations differ depending on the causes and severity of the disease. But, in general, they consist in attaching a stretched muscle in place, shortening an undeveloped muscle, or using a special bandage to lift the eyelid. In most cases, during surgery, the child is given general anesthesia.

Some treatments for upper eyelid ptosis may take several weeks until the eyelid rises to the desired height. During this period, the child will be under close supervision of an ophthalmologist.

Ptosis in children

Causes of ptosis of the upper eyelid in children

Causes of ptosis include trauma or birth defects that lead to muscle weakness or impaired neuromuscular transmission of the upper eyelid. The cause of ptosis in young children can be an injury received by the child during childbirth, neurofibroma (swelling of the nerve sheath in the upper eyelid) or hemangioma (swelling of the blood vessels).

Ophthalmoparesis, as one of the possible causes of ptosis in both eyes, leads to a symmetrical form of the disease and weakness of the orbicular muscle of the eyes.

The causes of ptosis of the upper eyelid of an acute form are, as a rule, neurogenic in nature. Eyelid prolapse is often observed in Horner's syndrome (pathology of sympathetic innervation). With this type of pathology, ptosis of the upper eyelid develops in only one eye.

The cause of ptosis of the senile form is age-related changes in the muscles of the eyelid and sagging of the skin that has lost its elasticity over the palpebral fissure.

Signs of ptosis of the upper eyelid in children

Diagnosis and treatment of ptosis of the upper eyelid in children

Diagnosis of ptosis is not difficult. To make a diagnosis, the height of the eyelid is measured, the symmetry and completeness of the movement of the upper eyelids of both eyes are checked.

Surgical treatment for ptosis of the upper eyelid is performed under local anesthesia. The exception is children: during operations with ptosis in children General anesthesia is recommended.

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Ptosis of the upper eyelid

General characteristics of the disease

Ptosis is an abnormal drooping of the upper eyelid. In this case, the patient partially or completely closes the palpebral fissure and, accordingly, the field of view. Therefore, ptosis is not only a cosmetic defect, but also a serious ophthalmic disease. Ptosis of the upper eyelid can lead to functional blindness.

Ptosis of the upper eyelid can be acquired or congenital. In children with a congenital form of the disease, ptosis is often combined with strabismus or amblyopia (lazy eye disease).

The treatment of ptosis is predominantly surgical.

Causes of ptosis of the upper eyelid

Whatever the causes of ptosis, patients need to consult an ophthalmologist.

Signs of ptosis of the upper eyelid

Diagnosis and treatment of ptosis of the upper eyelid

An alternative operation for ptosis of the upper eyelid is the technique of forming a duplication of the tarsoorbital fascia. It differs from the above-mentioned method of treating ptosis in the way it strengthens the crease of the eyelid. In addition to three p-shaped sutures, this operation for ptosis involves the use of diathermocoagulation (cauterization with a diathermic current) of the upper eyelid muscle membrane.

Surgical treatment for ptosis of the upper eyelid is performed under local anesthesia. The exception is children: during operations for ptosis in children, the use of general anesthesia is recommended.

Video from YouTube on the topic of the article:

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Plastic surgery / Correction of ptosis (drooping) of the upper eyelid

Ptosis upper eyelid is the drooping of the upper eyelid more than 2 mm below the upper edge of the iris (ideally, the edge of the upper eyelid covers the iris by about 1.5 mm), or below the other eyelid, when both eyes are compared. Ptosis of the upper eyelid occurs quite often, both in adults and in children, moreover, this condition can be congenital, or it can develop during life due to stretching and thinning of the aponeurosis of the muscle that lifts the upper eyelid. Also, ptosis of the eyelid can appear at any age as a result of an injury to the upper eyelid or an eye disease.

The structure of the muscular apparatus that lifts the upper eyelid.

1 - Ligament apparatus; 2 - Transition of the muscle that lifts the upper eyelid into the aponeurosis; 3 - Tarsal plate (cartilage of the eyelid); 4 - Aponeurosis of the muscle that lifts the upper eyelid; 5 - The muscle that lifts the upper eyelid

It is important to distinguish congenital eyelid ptosis from acquired, because the techniques aimed at correcting acquired eyelid ptosis and congenital are different from each other. Due to the fact that the development of congenital ptosis of the eyelid is the result of dystrophy of the muscle that lifts the upper eyelid, and not its aponeurosis, its (muscle) elongation and compaction (fibrosis) occurs.

congenital ptosis

Acquired ptosis

Patients with acquired ptosis have a more elastic and resilient muscle that lifts the upper eyelid and can usually close the eye when looking down. Incomplete closure of the upper eyelid, with a maximally lowered gaze, and a small amplitude of movements of the upper eyelid can be an important help in differentiating congenital ptosis of the eyelid. Congenital ptosis of the upper eyelid is more often unilateral, acquired - more often occurs on both sides.

The treatment of ptosis of the upper eyelid is performed with the help of an operation, in the case of congenital ptosis, aimed at shortening the levator levator muscle, in the case of acquired ptosis, aimed at shortening the stretched aponeurosis of this muscle.

Surgery to correct ptosis of the upper eyelid

The operation for the correction of ptosis of the upper eyelid can be performed both under local anesthesia and under anesthesia and lasts from 30 minutes to 1 hour.

During the operation for acquired ptosis on the upper eyelid, a thin strip of skin is removed, the orbital septum is cut, the aponeurosis of the muscle that lifts the upper eyelid is cut under it, the aponeurosis is shortened and sutured to the tarsal plate (eyelid cartilage) a little lower.

Drooping upper eyelid (ptosis)

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Upper eyelid droop

Normally, the iris is closed by the edge of the upper eyelid by about 1.5 mm. They say about ptosis (blepharoptosis) if the eyelid falls below the upper edge of the iris by 2 or more millimeters or is below the eyelid of the other eye when they are compared. Upper eyelid droop can be either congenital or lifelong, so blepharoptosis is quite common among children and adults.

The drooping of the upper eyelid is not only a cosmetic defect, but also interferes with the normal development and functioning of the visual analyzer, causing a mechanical difficulty in vision. Correction of the drooping of the upper eyelid is done by plastic surgery and ophthalmology.

Classification

According to the time of development, congenital and acquired blepharoptosis are distinguished. Depending on the degree of severity, the drooping of the upper eyelid can be partial (the edge of the eyelid covers the upper third of the pupil), incomplete (the edge of the eyelid is lowered to half the pupil) and complete (the upper eyelid covers the entire pupil). Ptosis can be unilateral (69%) or bilateral (31%).

Depending on the etiology of the drooping of the upper eyelid, the following types of ptosis are distinguished: aponeurotic, neurogenic, myogenic, mechanical ptosis and pseudoptosis (false).

The reasons

The lifting of the eyelid is carried out due to the functioning of a special muscle that lifts the upper eyelid (levator), which is innervated by the oculomotor nerve. Therefore, the main causes of the drooping of the upper eyelid can be associated either with an anomaly of the muscle that lifts the eyelid, or with the pathology of the oculomotor nerve.

Congenital drooping of the upper eyelid may be based on underdevelopment or complete absence of the levator muscle; in rare cases, aplasia of the nuclei or pathways of the oculomotor nerve. Congenital blepharoptosis is often familial, but it can also be caused by abnormal pregnancy and childbirth. Congenital drooping of the upper eyelid in most cases is combined with another pathology of the organ of vision: anisometropia. strabismus. amblyopia, etc.

Aponeurotic blepharoptosis most often develops against the background of involutional changes associated with the natural aging process of the body. Sometimes the cause of the drooping of the upper eyelid is trauma to the levator aponeurosis or its damage during ophthalmic operations.

Neurogenic ptosis of the upper eyelid is a consequence of diseases nervous system: stroke. multiple sclerosis. paresis of the oculomotor nerve, meningitis. tumors and abscesses of the brain, etc. Omission of the upper eyelid of a neurogenic nature is observed in Horner's syndrome, characterized by paralysis of the cervical sympathetic nerve, retraction of the eyeball (enophthalmos) and pupillary constriction (miosis). The causes of myogenic blepharoptosis may be myasthenia gravis. muscular dystrophy, congenital myopathy. blepharophimosis.

Mechanical drooping of the upper eyelid may be due to retrobulbar hematoma, eyelid tumors, or orbital damage. deformation of the eyelid as a result of ruptures, injuries by foreign bodies of the eye. scarring.

Pseudoptosis (false, apparent drooping of the upper eyelid) occurs with excess skin on the upper eyelid (blepharochalasis), strabismus, hypotension of the eyeball.

Symptoms

Blepharoptosis is manifested by unilateral or bilateral drooping of the upper eyelid varying degrees severity: from partial covering to complete closure palpebral fissure. Patients with droopy upper eyelids are forced to tense the frontalis muscle, raise their eyebrows, or tilt their head back in order to better see with the affected eye (stargazer posture). The drooping of the upper eyelid makes it difficult to perform blinking movements, which, in turn, is accompanied by increased fatigue, irritation and infection of the eyes.

Congenital blepharoptosis is often combined with strabismus, epicanthus, paresis of the superior rectus muscle. The constant covering of the eyeball with the eyelid eventually leads to the development of amblyopia. With acquired drooping of the upper eyelid, diplopia, exophthalmos, or enophthalmos are often noted. violation of the sensitivity of the cornea.

Due to the variety of mechanisms leading to the drooping of the upper eyelid, differential diagnosis and correction of ptosis require joint management of the patient by an ophthalmologist. neurologist. plastic surgeon.

Diagnostics

The primary diagnosis of drooping of the upper eyelid is carried out during a visual examination. During a physical examination, the height of the position of the eyelid, the width of the palpebral fissure, the symmetry of the location of the eyelids of both eyes, the mobility of the eyeballs and eyebrows, the strength of the levator muscle, the position of the head, and other functional indicators are evaluated.

In case of mechanical ptosis, in order to exclude damage to bone structures in the levator region, a survey radiography of the orbit is indicated. If a neurogenic nature of the drooping of the upper eyelid is suspected, a CT scan (MRI) of the brain is performed, a consultation with a neurologist and a neurosurgeon is carried out.

Treatment

First of all, the treatment of ptosis of the upper eyelid is aimed at eliminating the functional pathology and only then - at correcting the cosmetic defect.

In the case of the neurogenic nature of the drooping of the upper eyelid, the underlying pathology is treated; additionally appointed local physiotherapy - galvanization. UHF. paraffin therapy.

With congenital drooping of the upper eyelid, as well as the lack of effectiveness of conservative therapy for acquired ptosis within 6-9 months. resort to methods of surgical ophthalmology. The timing of correction of congenital blepharoptosis is set differentially: partial drooping of the upper eyelid is operated on at 13-16 years; full ptosis, in view of the likelihood of developing amblyopia, it is advisable to eliminate in preschool childhood.

Operations for the drooping of the upper eyelid (ptosis correction) are aimed either at shortening the muscle that lifts the upper eyelid (congenital ptosis) or at shortening the levator aponeurosis (acquired ptosis).

With congenital ptosis, the levator is isolated, the muscle is plicated (shortened) by excision or by creating a duplication. In case of severe blepharoptosis, the levator lid muscle is sutured to the frontalis muscle.

The standard operation for acquired blepharoptosis is to remove a thin strip of skin from the upper eyelid, resect the aponeurosis, and fix its lower edge to the cartilage of the upper eyelid. AT plastic surgery drooping upper eyelid correction can be combined with upper blepharoplasty.

Forecast

The aesthetic and functional result of blepharoptosis correction with the right surgical tactics is usually preserved for life. When lowering the upper eyelid due to ophthalmoplegia. treatment can achieve only a partial effect. Surgical treatment of myogenic ptosis caused by myasthenia gravis is ineffective.

Left untreated, drooping upper eyelids can eventually lead to amblyopia and vision loss.

Ptosis of the eyelid, or blepharoptosis, is the drooping of the upper eyelid in relation to the edge of the iris by more than 2 mm. It is not only a cosmetic defect, but can be a symptom of a certain pathology and lead, especially in children, to a persistent decrease in visual acuity.

Symptoms and classification of ptosis of the occurrence of ptosis of the upper eyelid

The main symptoms are:

visually noticeable directly blepharoptosis;
sleepy facial expression (with bilateral lesions);
the formation of forehead skin wrinkles and a slight raising of the eyebrows when trying to compensate for ptosis;
rapid onset of eye fatigue, a feeling of discomfort and soreness with a load on the organs of vision, excessive tearing;
the need to apply effort to close the eyes;
over time or immediately occurring strabismus, decreased visual acuity and double vision;
"stargazer's posture" (slight tilting of the head backwards), which is especially characteristic of children and is an adaptive reaction aimed at improving vision.

The mechanism of development of this symptomatology and directly the ptosis itself is as follows. The motor functioning of the eyelid and the width of the palpebral fissure depend on the tone and contractions:

Levator of the upper eyelid (levator muscle), which controls the vertical position of the latter;
The circular muscle of the eye, which allows you to steadily and quickly close the eye;
The frontal muscle, which contributes to the contraction, compression of the eyelid with a maximum gaze upward.

Tone and contraction are carried out under the influence of nerve impulses coming to the circular and frontal muscles from facial nerve. Its nucleus is located in the brainstem on the corresponding side.

The muscle that lifts the upper eyelid is innervated by a group of neurons (right and left bundles of the central caudal nucleus), which are part of the nucleus of the oculomotor nerve, also located in the brain. They go to the muscles of their own and the opposite side.

Video: Ptosis of the upper eyelid

Ptosis classification

It can be bilateral and unilateral (in 70%), true and false (pseudoptosis). False ptosis is caused by excess skin volume and subcutaneous tissue, eyelid hernia, strabismus, decreased elasticity of the eyeballs and, as a rule, is bilateral, with the exception of unilateral endocrine pathology of the eye.

In addition, a distinction is made between physiological and pathological drooping of the eyelids. The above groups of nerves are associated with the sympathetic nervous system, with the retina, with the hypothalamus and other brain structures, as well as with the frontal, temporal and occipital regions of the cerebral cortex. Therefore, the degree muscle tone and the width of the palpebral fissure in the physiological state are in close relationship with the emotional state of a person, fatigue, anger, surprise, reaction to pain, etc. Blepharoptosis in this case is bilateral and is intermittent, relatively short-lived.

Pathological ptosis, on the other hand, occurs with injuries or inflammatory processes of the eyeball or muscles that move the eyelid, with inflammatory processes of the meninges and with violations of the various levels(nuclear, supranuclear and hemispheric) in the conduction nervous system with heart attacks and brain tumors, disorders of sympathetic innervation and transmission of nerve impulses to muscles, with damage to the upper roots spinal cord, lesions of the brachial plexus (plexopathy), etc.

Depending on the degree pathological condition distinguish:

Partial ptosis, or I degree, in which 1/3 of the pupil is covered by the upper eyelid.
Incomplete (II degree) - when half or 2/3 of the pupil is covered.
Full (III degree) - complete covering of the pupil.

Depending on the cause, blepharoptosis is divided into:

Congenital.
Acquired.

congenital pathology

Congenital ptosis of the upper eyelid occurs:

With congenital Horner's syndrome, in which ptosis is combined with pupillary constriction, dilation of conjunctival vessels, weakening of sweating on the face and a barely noticeable deeper location of the eyeball;
In Marcus-Hun syndrome (palpebromandibular synkinesis), which is a drooping of the eyelid that disappears during opening of the mouth, chewing, yawning or shifting mandible in the opposite direction. This syndrome is a consequence of a congenital pathological connection between the nuclei of the trigeminal and oculomotor nerves;
With Duane's syndrome, which is a rare congenital form of strabismus, in which there is no ability to move the eye outward;
As an isolated ptosis due to the complete absence or abnormal development of the levator or its tendon. This congenital pathology very often inherited and almost always bilateral;
With congenital myasthenia gravis or anomalies of the innervation of the levator;
Neurogenic etiology, in particular with congenital paresis of the third pair of cranial nerves.

Video: Congenital ptosis of the upper eyelid in children

Congenital ptosis of the upper eyelid in children

Acquired ptosis

Acquired ptosis, as a rule, is unilateral and develops most often due to injuries, age-related changes, tumors or diseases (stroke, etc.), which result in paresis or paralysis of the levator.

Conventionally, the following main forms of the acquired pathological condition are distinguished, which can also be of a mixed nature:

aponeurotic

The most common cause is involutional age-related drooping of the upper eyelid as a result of dystrophic changes and weakness of the muscular aponeurosis. Rarely, the cause may be traumatic injury, long-term treatment corticosteroid drugs.

myogenic

Occurs usually with myasthenia gravis or myasthenic syndrome, muscular dystrophy, blepharophimosis syndrome, or as a result of ocular myopathies.

neurogenic

It occurs mainly as a result of violations of innervation by the oculomotor nerve - with the syndrome of aplasia of the latter, its paresis, Horner's syndrome, multiple sclerosis, stroke, diabetic neuropathy, intracranial aneurysms, ophthalmoplegic migraine.

In addition, neurogenic ptosis also occurs when the sympathetic pathway is damaged, which begins in the hypothalamic region and the reticular formation of the brain. Blepharoptosis associated with damage to the oculomotor nerve is always combined with pupil dilation and impaired eye movement.

Violation of the transmission of impulse from the nerve to the muscle often occurs like its counterparts (Dysport, Xeomin) in the upper third of the face. In this case, blepharoptosis may be associated with impaired fun

the action of the eyelid itself as a result of the diffusion of the toxin into the levator. However, most often this condition develops as a result of local overdose, penetration or diffusion of the substance into the frontalis muscle, its excessive relaxation and aggravation of overhanging skin folds.

Mechanical

Or completely isolated ptosis due to inflammatory process and edema, isolated levator lesion, scarring, pathological process in the orbit, for example, a tumor, damage to the anterior part of the orbit, unilateral atrophy of the muscles of the face, for example, after a stroke, significant tumor formation of the eyelid.

Blepharoptosis of the upper eyelid after blepharoplasty

It can be in the form of one of the listed forms or their combination. It occurs as a result of postoperative inflammatory edema, damage to the outflow tracts of the intercellular fluid, as a result of which its outflow is disturbed and tissue edema develops, damage to the muscles or muscle aponeurosis, as well as hematomas that limit their function, damage to the endings of the nerve branches, the formation of coarse adhesions.

How to treat this pathological condition?

Acquired ptosis of the upper eyelids

There are conservative treatments and various surgical techniques. Their choice depends on the cause and severity of the pathology. As a very short-term auxiliary method, correction of the ptosis of the upper eyelid by fixing the latter with an adhesive plaster can be used. This method is used mainly as a temporary and additional one, when it is necessary to eliminate complications in the form of inflammation of the conjunctiva, as well as in case of complications after botulinum therapy.

Treatment of ptosis of the upper eyelid after Botox, Dysport, Xeomin

It is carried out by introducing prozerin, taking increased doses of vitamins “B 1” and “B 6” or administering them in solutions by injection, performing physiotherapy (electrophoresis with a solution of prozerin, darsonval, galvanotherapy), laser therapy, massage of the upper third of the face. At the same time, all these measures only slightly contribute to the restoration of muscle function. Most often it occurs on its own within 1-1.5 months.

Non-surgical therapy

Treatment of ptosis of the upper eyelid without surgery is also possible with false blephroptosis or, in some cases, a neurogenic form of this pathological condition. Correction is carried out in physiotherapy rooms through the use of the above physiotherapy and massage. Treatment at home is also recommended - this is massage, gymnastics to increase tone and strengthen the muscles of the upper third of the face, lifting cream, lotions with infusion of birch leaves, with a decoction of parsley root, with potato juice, processing with ice cubes with infusion or decoction of appropriate herbs.

Gymnastic exercises for ptosis of the upper eyelid are:

circular eye movement, look up, down, right and left with a fixed head;
the maximum possible opening of the eyes for 10 seconds, after which it is necessary to close the eyes tightly and tighten the muscles for 10 seconds as well (repeat the procedure up to 6 times);
repeated sessions (up to 7) of fast blinking for 40 seconds with the head thrown back;
repeated sessions (up to 7) of lowering the eyes with the head thrown back with a delay in looking at the nose for 15 seconds and followed by relaxation, and others.

It should be noted that all conservative methods of treatment are mainly not curative, but preventive. Sometimes, in the first degree, with the above forms of blepharoptosis, conservative therapy only slightly improves or slows down the progression of the process.

In all other cases of the pathological condition and with blepharoptosis II or III degree, it is necessary to use surgical methods.

An upper eyelid defect is known as blepharoptosis, or ptosis for short. The disease can develop under the influence of many reasons and is a cosmetic flaw that can be treated therapeutically.

Etiology of the pathological condition

Ptosis can affect one or both upper eyelids and is subdivided into:

for unilateral defeat;
bilateral - with the fall of both eyelids.

The severity of changes directly depends on the severity of the process:

primary - characterized by partial drooping of the upper eyelid, with the eyeball covered by no more than 33%;
secondary - in case of deviation, a significant omission is recorded, the visible area reaches 33 - 66%;
tertiary - total drooping of the upper eyelid completely covers the pupil area, visibility is zero.

The pathological process occurs in stages, with a gradual fall of the upper skin fold. In certain periods of time, deformation changes become more pronounced.

Experts distinguish several stages of the disease:

First, visual changes are almost imperceptible. There is a weakening of the facial muscle, bags, folds and dark circles begin to form around the eyes.
The second is characterized by the formation of a clear delimitation of the territory between the area of the eyes and cheeks.
The third - noticeable manifestations are expressed in the omission of the upper eyelids almost to the area of the pupils. From the outside, there is a feeling that the patient has a constantly sad, upset, dull and expressionless look. It creates the effect of a glance from under the brows or a frowning, dissatisfied person.
Fourth - a deepened nasolacrimal groove contributes to the omission of not only the upper eyelids, but also the corners of the eyes. The changes that have appeared change the age of the patient - he looks much older.

Ptosis is registered when the distance between the borders of the upper eyelid and the iris is more than 1.5 mm.

Background and causes of ptosis

The causes of the development of the disease are various external factors. The disease is considered from the point of view of a congenital and acquired defect.

Developed under the influence of various prerequisites, the acquired form is further divided:

Aponeurotic - a pathological deviation affects the structures that regulate the lifting of the eyelids. Muscle fibers that have been stretched or damaged are characterized by impaired functionality. The formation of the disease occurs under the influence of inevitable changes, the risk group includes patients of the elderly age period.
Neurogenic - caused by impaired activity nerve fibers, responsible for the motor functionality of the eyes. The deviation is formed under the influence of causes associated with a disorder in the working capacity of the nervous system:
- multiple sclerosis;
- stroke lesions;
- neoplasms in the brain;
- brain abscess in the cranium.
Mechanical - this variant of the pathology leads to a shortening of the upper eyelid in the horizontal plane. The deviation occurs under the influence of factors:
- in the presence of neoplasms in the eyes;
- injuries through foreign bodies caught in the eyes;
- breaks in the integrity of the mucous membranes and other areas;
- due to the ongoing scarring process.
Myogenic - is recorded after the formation of myasthenic syndrome - an autoimmune type of chronic lesion, leading to a decrease in overall muscle tone and increased fatigue.
False - the disease occurs under the influence of the following pathological conditions:
- severe degree of strabismus;
- excess skin of the eyelids.

The congenital variant of ptosis is formed under the influence of certain intrauterine growth factors:

insufficient development or complete absence of the muscle responsible for the process of lifting the upper eyelid;
blepharophimosis - refers to rarely recorded genetic anomalies, characterized by shortening of the eye slits (in the vertical or horizontal plane) due to the fused edges of the eyelids or chronic conjunctivitis;
palpebromandibular syndrome - dysfunction of the system responsible for lifting the eyelids, due to lesions brain stem with associated complications of strabismus or amblyopia.

An additional characteristic of the Marcus-Gunn syndrome is the involuntary opening of the palpebral fissure at the time of speaking, chewing, or other jaw vibrations.

Symptomatic manifestations

Pathological deviation is accompanied by various symptoms. Common signs of ptosis include:

pronounced omission of the borders of the upper eyelid;
slight outwards;
small volume of the affected eye;
shortened palpebral fissure;
falling massive fold at the upper part of the eyelid;
eyes set close to each other;
rapid fatigue of the organs of vision;
frequent hyperemia and irritation of the mucous membranes;
decreased visual acuity;
sensation of foreign objects in the eyeballs;
sharp constriction of the pupil;
bifurcation in front of located objects;
rare or absent blinking;
constant movement of the eyebrows;
involuntary tilting of the head back to raise the lowered eyelid;
inability to tightly close the eyelids;
in some cases - strabismus.

In exceptional cases, the lesion may be accompanied by symptomatic manifestations:

myasthenic syndrome, sensation constant fatigue and weakness in the afternoon;
myopathy, weakening of muscle structures that provoke partial covering of the eyelids;
involuntary lifting of the eyelids during movements of the jaw and during the opening of the oral cavity;
palpebral dysfunction, expressed in the fall of the upper section and eversion of the lower, obvious narrowing of the palpebral fissure;
simultaneous drooping of the eyelid, retraction of the eye and constriction of the pupil is a symptom of Claude Bernard-Horner.

Ptosis in children

Ptosis in children is divided into congenital and acquired. Ptosis is often combined with other disorders of the functionality of the eyes, which are dominated by:

heterotropia - a pathology that makes it difficult to concentrate both eyes on one object, with a violation of their coordination;
- a deviation in which one of the organs of vision is not involved and the brain receives different pictures that it cannot combine into a single whole;
- a disease characterized by a significant difference in the refraction of the eyes, can be combined with astigmatism and proceed without it;
diplopia - a violation, as a result of which all objects in the field of view double.

Ptosis may be a manifestation common diseases. The main prerequisites for the development of the disease in babies include:

injuries received at the time of passage of the birth canal;
dystrophic type of myasthenia - related to severe forms autoimmune lesions affecting muscle fibers and nerves;
neurofibromas - a neoplasm that occurs on the sheaths of the nerves of the upper eyelid;
ophthalmoparesis - partial immobilization eye muscles;
hemangioma - a tumor-like formation that forms on the vessels.

congenital ptosis

It has classification features associated with the root causes of the development of a pathological condition in childhood:

Dystrophic form - refers to the most frequently recorded, arising:
- when deviating from the standard development of the structures of the upper eyelid;
- with weakness of the muscle elements of the upper muscle;
- at dystrophic changes levator;
- with blepharophimosis - a genetically predisposed insufficient development of the palpebral fissure.
Non-dystrophic form - characterized by stable performance of the muscles of the upper eyelids.
Congenital neurogenic - is formed with paresis of the third pair of cranial nerves.
Myogenic - is transmitted through the hereditary line from mother to child.
Pathology associated with the phenomenon of Markus Gunn is a condition characterized by spontaneous lifting of the upper eyelids, which is formed when opening the mouth, swallowing movements, abducting the lower jaw to the side (any functions performed by the chewing department).

Acquired Variant

Ptosis of this type in babies has its own prerequisites for education and subspecies:

Deviation resulting from defective aponeurosis, characterized by the presence of excess skin folds and often occurring swelling of the eyelids. Almost all fixed variants affect both eyes.

Neurogenic ptosis has its own varieties and causes:

lesion of the motor pathway, located in the region of the third pair of cranial nerves;
congenital Horner's syndrome - characterized by the receipt of trauma at the time the child passes through the birth canal or other unclear origin;
acquired Horner's syndrome - as a sign of damage to the nervous system, which is formed after surgical interventions in the area chest or due to neuroblastoma ( malignant neoplasm, developing exclusively in childhood age period).

Myogenic ptosis - is recorded in the presence of pathological abnormalities:

with existing myasthenia - arising against the background of underdevelopment and neoplasms in the thymus gland, characterized by lesions of the eye muscles, doubling in front of located objects and asymmetry;
with progressive external - partial paralysis of the nerves of the cranial region responsible for the innervation of the eye muscles.

Mechanical - formed as a result of scar tissue and neoplasms on skin upper eyelid.

False - fixed in case of disorders and disturbances in the movements of the eyeball up and down, in the presence of extra skin folds in the area of the upper eyelid and with tumor-like formations on the vessels (hemangiomas).

Symptomatic manifestations and the scheme of therapy in the children's age period practically does not differ from the adult. Surgical manipulations for the treatment of blepharoptosis in babies are performed after they reach three years of age and subject to the introduction of general anesthesia. Until the age of three, the organs of vision are formed in children and the operation does not make logical sense.

Diagnostic studies

When contacting a medical institution about a developed deviation, the patient is sent for a number of research procedures:

to measure the length of the upper eyelid in a vertical plane;
determination of general muscle tone;
assessment of the symmetry of skin folds in the process of blinking;
obligatory consultation of a neurologist;
conducting electromyography - for a comprehensive assessment of bioelectrical indicators of muscle potential;
radiographic image of the orbit area;
ultrasound examination of the eye area;
MRI of the brain;
identification of the existing degree of strabismus;
binocular vision test;
- determination of the optical features of the organs of vision;
perimetric diagnostics;
determination of the level of ocular convergence - the level of convergence of visual axes at the time of consideration of a closely located object.

After carrying out diagnostic measures, the attending physician makes the final diagnosis and enters the total received clinical picture diseases in the patient's card. The specialist prescribes the necessary treatment regimen, based on the data obtained and general condition organism.

Ptosis treatment

The main method of correcting the pathological condition is surgical intervention. Surgical correction of the affected area is performed under the influence of local anesthetics. medicines, general anesthesia is used in the children's age period.

The total duration of the manipulation is about one and a half hours, the therapy is in the standard scheme:

on the area of the upper eyelid, a small piece of skin is removed;
an incision is made in the orbital septum;
the division of the aponeurosis responsible for raising the upper eyelid is carried out;
the damaged part of the aponeurosis is excised;
the remaining area is sutured to the lower cartilage of the eyelid;
suture material is applied on top;
the wound surface is treated with a sterile dressing.

Surgical intervention is allowed to be performed after the treatment of the pathology, which is the root cause of the development of ptosis.

Commonly prescribed treatment options for ptosis include:

the use of electrophoresis;
local exposure to UHF therapy;
myostimulation;
galvanotherapy;
laser therapy;
fixation of the damaged eyelid with a plaster.

Injection Therapy

The latest development to suppress the symptoms of blepharoptosis is the use of injection medicines containing botulinum toxins:

"Dysport";
"Lantoksa";
"Botox".

Their spectrum of action is aimed at forced relaxation of the muscle fibers responsible for lowering the eyelid. The field of vision returns to normal after the procedure.

Before manipulation, the specialist collects anamnestic data:

injuries that have taken place;
chronic or inflammatory diseases;
all types of medications taken;
tendency to spontaneous allergic reactions;
hereditary factor - how many family members suffered from similar ailments.

At total absence contraindications, after clarification of the factors that influenced the onset of the disease, and the appointment of a full-fledged treatment regimen, the initial preparation for the procedure takes place. In the preoperative period, the patient signs the consent to the proposed therapy option, he is fully informed about the chosen method.

Required level of concentration medication determined by the doctor during a visual examination of the damaged area. Subcutaneous and intradermal types of injection are made with insulin syringes. Before the manipulation, the surgical field is treated with antiseptics, the places for future punctures are outlined.

The total duration of the manipulation is five minutes, there is practically no pain. At the end of the procedure, the injection sites are treated with disinfectants for the second time, the sick person is under the supervision of the attending physician for another half an hour.

At the end of the manipulation measures, the rules of the postoperative period are announced to the patient for the second time:

during the first four hours, be exclusively in an upright position;
it is forbidden to bend and lift heavy things;
it is not recommended to touch and knead the injection sites;
the use of alcoholic, low-alcohol drinks is prohibited;
do not touch puncture sites high temperatures- under the ban are all warming and pressure bandages, compresses;
it is strictly forbidden to visit saunas, baths and steam rooms - in order to avoid the destruction of the positive effect.

Restrictions apply for a weekly period. The desired result is recorded two weeks after the manipulation and lasts for six months, with a gradual weakening. Therapeutic impact "Botox" is a real substitute for surgical intervention in partial or incomplete form of ptosis of the upper eyelid.

home therapy

Self-elimination of the pathological condition is of an auxiliary nature at the primary stages of the development of the deviation. To suppress a cosmetic defect, it is recommended to use:

specialized compresses;
masks;
gymnastic exercises - to strengthen the muscles of the facial region.

In the absence of the desired result, the patient needs a doctor's consultation and further treatment in a hospital.

Gymnastics from ptosis - helps to strengthen relaxed muscles and includes the periodic performance of certain exercises:

Wide open eyes performed circular motions- A thorough inspection of the surrounding objects is carried out. Without closing the eyes, attempts are made to squint. The repetition of the technique is carried out several times in a row.
The maximum opening of the eyes and holding them in this position for 10 seconds. This is followed by a tight closure, with muscle tension, for 10 seconds. A total of six repetitions are performed.
Index fingers are placed in the eyebrow area. After light pressure, they are brought together, without the formation of a wrinkled fold. The stage should be performed before the appearance of pain in the muscles.
The eyebrow area is massaged with the index finger, by stroking and gentle pressure.

Muscular gymnastics allows you to tighten weakened facial muscles. Manipulations are prohibited in infectious and inflammatory processes affecting the areas of the upper eyelid.

Medicated creams – are among the most simplified means for the treatment of ptosis. Pharmaceutical and cosmetic companies produce a sufficient number of creams with a tightening effect.

The effectiveness of the impact depends on the degree of damage - in the initial phases, the funds produce a positive effect - subject to daily use. At the end cosmetic procedures all efficiency will quickly subside and the state will return to its original state.

Preventive actions

To prevent secondary or primary formation of ptosis, experts recommend that patients change their usual lifestyle:

reconsider the principles of the daily diet - use foods enriched essential vitamins and minerals;
exclude alcoholic, low-alcohol drinks;
treat chronic nicotine and drug addiction;
go in for sports regularly - daily walks in forest park areas, training, gymnastics, swimming;
stabilization of the schedule of rest and work - night sleep should be at least eight hours, it is necessary to go to bed and get up at the same time.

As a preventive measure in the elderly, it is recommended:

take place regularly preventive examinations at an ophthalmologist;
timely treat eye diseases;
visit a neurologist periodically.

Therapy of changes that have arisen under the influence of aging of the body is impossible at home. To suppress negative symptoms, you should contact the local clinic, pass all the necessary tests and get a symptomatic treatment regimen.

Ptosis is a disease that requires timely treatment for medical care. With an advanced form of pathological deviation (above the second stage), the only treatment option will be mandatory surgical intervention. Ignoring the primary signs of the disease will allow the rapid progression of the disease.