Ptosis of the upper eyelid: causes

Asymmetry of the upper eyelid of one of the eyes in relation to the other is a cause for alertness.A similar symptom may indicate a disease such as ptosis. With this disease a person not only looks older than there is in reality, but also tired and bleak. And all due to the fact that you have to apply enough strength to just blink, tilt your head to see well. In this article we will analyze the causes and symptoms of the ptosis of the upper eyelid, and also tell you how to treat it correctly.

What it is

Ptosis (blepharoptosis) is the descent of the upper eyelid, which leads to narrowing of the eye gap.Normally, the upper eyelid covers the iris of the eye by about a half millimeter. When the eyelid closes the eye by two millimeters or more, this indicates a ptosis.

The upper eyelid rises with the help of a muscle that can work normally if it receives nerve impulses along the oculomotor nerve channel.

But if for some reason the nerve is damaged, the impulse does not reach the muscle, which leads to the omission of the eyelid.

Sometimes other pathologies are taken for ptosis. For example, the eyelid can be lowered due to its insufficient support by the eyeball, the same happens with ipsilateral hypotrophy, with ptosis eyebrows, dermatolysis, and so on.

Blepharoptosis is congenital and acquired. It can appear in both children and adults.

The reason for the appearance of congenital ptosis of the upper eyelid is the underdeveloped levator muscles.In addition, their innervation may be impaired due to developmental abnormalities, severe pregnancy and childbirth.

Anatomy of the circular muscle of the eye

Satellites of congenital ptosis often have strabismus, anisometropia and other.

Acquired ptosis has several varieties:

1. Aponeurotic.It arises because the aponeurosis of the muscles is stretched and weakened. One of the subspecies of aponeurotic ptosis is senile or involutional ptosis. It is a sign of physiological aging.
2. Neurogenic.This blepharoptosis is the result of damage to the nervous system, or disease or injury. In addition to lowering the upper eyelid, the eyeball may fall and the pupil narrow (Horner's syndrome).
3. Mechanical.This kind of ptosis occurs with the deformation of the eyelids, which can arise due to scarring, ruptures and so on.
4. False.This ptosis is also called apparent. It appears with strabismus, hypotension of the eyeballs and with excess folds on the eyelids.

Types of ptosis of the upper eyelid

Another classification of ptosis of the upper eyelid is based on the severity of the disease:

1. Partial blepharoptosis.The edge of the eyelid is located on the upper third of the pupil.
2. Incomplete blepharoptosis.The edge of the century is located at the level of the middle of the pupil.
3. Complete blepharoptosis. The pupil is closed by the eyelid completely.

Also ptosis can be one-sided and two-sided. In the first case, the disease affects one eye, and the second one immediately two.

Causes

Congenital and acquired ptosis of the upper eyelid have different causes of occurrence.So the causes of congenital disease are:

• The underdeveloped muscle of the upper eyelid due to a genetic or hereditary disorder. It happens that the muscle may be completely absent.
• Underdeveloped nucleus of the oculomotor nerve due to neurological disorders during intrauterine development.

The causes of acquired blepharoptosis:

• Injuries or diseases of the nervous system that lead to paralysis of the oculomotor nerves.
• Full or partial paralysis of the muscle lifting the upper eyelid.
• Age changes.They affect the elasticity and strength of the ligaments and muscles, so the skin of the eyelids begins to sag.
• Chronic diseases of internal organs, diabetes, pathology of nerves.
• Medical procedures performed on the face and eyes.

False ptosis appears due to hysteria or nervous tic, strabismus, excess skin on the eyelid.

Ptosis of the upper eyelid may be a sign of some serious disease, so you need to conduct a complete examination in order to avoid unpleasant consequences.

Symptoms

The most important symptom of ptosis is the descent of the upper eyelid, which can be one-sided or bilateral and has different severity.A person who has such a disease as blepharoptosis, often has to strain the muscles of his forehead, raise his eyebrows and throw his head back.All this he has to do to better see. In addition, it becomes difficult for a person to blink, which leads to fatigue, irritation and infectious diseases of the eyes.

The severity of ptosis

Additional symptoms of congenital ptosis of the upper eyelid:

• Strabismus;
• Epicanthus(fold near the inner corner of the eye);
• Paresis of the upper rectus muscle of the eye(incomplete paralysis).

If the eye is permanently closed by the eyelid, it can lead to the appearance of amblyopia (decreased visual function).

Additional symptoms of acquired ptosis:

• Diplomacy (double image);
• Exophthalmos (shift of the eyeballs anteriorly);
• Enophthalmos (deep position of eyeballs);
• Reducing the sensitivity of the cornea.

Diagnostics

The main goal of diagnosing ptosis of the upper eyelid is to establish the cause that led to the development of this disease.

To establish the cause, the physician must:

Surgical correction of ptosis

1. Assess the position and mobility of the century.
2. Evaluate the symmetry of eye movements.
3. Assess the mobility of the eyebrows.
4. Determine the size of the fold of the eyelid.
5. Determine the strength of the muscle that lifts the upper eyelid.
6. Determine the presence of strabismus, amblyopia.
7. Check your vision.
8. Measure the intraocular pressure.

The specialist should clarify the patient's information about the presence of blepharoptosis in his parents. The method of treatment of this disease depends on this.

If the ptosis is caused by mechanical damage, the doctor should check the bone structures for damage. To do this, you need to conduct an overview radiography.If there is a suspicion that the ptosis has appeared because of problems with the nervous system, then a computer or magnetic resonance imaging of the brain is conducted, a direction is given to the neurologist and neurosurgeon.

Treatment

It should be remembered that the ptosis of the upper eyelid can not simply disappear. To cure this disease, surgery is required.

The earlier treatment was started, the greater the chance of preserving vision.

If the ptosis was caused by a chronic disease, then for the beginning it is necessary to eliminate this factor, and already after the operation.The operation is performed by an ophthalmic surgeon under local anesthesia.In the case of surgery, children are

general anesthesia. The procedure lasts for about an hour and a half on average.

Stages of the operation:

1. Removal of a strip of skin on the upper eyelid.
2. Cutting of the orbital septum.
3. Separation of muscular aponeurosis.
4. Removal of a part of the muscle (shortening).
5. Sewing the muscle to the cartilage of the eyelid.
6. Application of cosmetic suture.

After the operation, a sterile bandage is applied for a couple of hours.

Bruises and swelling pass within a week after the surgical intervention.

Cure ptosis at home will not work, the exception is only the age-old descent of the upper eyelid. To do this, you can use a variety of cosmetics, nourishing and tightening the skin of the eyelids.

But do not expect a quick result, especially if the ptosis is strongly pronounced.

The operation to correct ptosis. Before and after the procedure

Complications

After the operation to eliminate the ptosis of the upper eyelid, the following complications can sometimes occur:

• Conjunctivitis.But it quickly passes with proper treatment.
• Lachrymation, fear of light, vision disorders, sagging of eyelids.These complications are temporary and soon disappear.
• After the operation, asymmetry sometimes appears.It disappears with time, but in some cases it can persist forever.
• Very rarely there can be a reversal of the eyelids.It requires conservative treatment, sometimes one more operation is needed.

Prevention

As preventive measures preventing the appearance of ptosis of the upper eyelid, experts call:

1. Timely diagnosis of this disease, treatment of diseases that cause ptosis;
2. Careful examination and management of pregnancy;
3. Compliance with the daily routine;
4. Refusal from alcohol and narcotic substances;
5. Physical activity;
6. Proper nutrition.

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conclusions

Take care of your health should always be. If suddenly you are confronted with the ptosis of the upper eyelid, do not be afraid, it is better to see a doctor as soon as possible and solve this problem. Timely treatment will prevent a variety of diseases, including strabismus in children or adults.