Ptosis of the eyelids: can a cosmetic defect take away vision? Eyelid drooping The eyelid of the left eye drops.

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The term "ptosis" in Greek means "omission". This disease is also called - blepharoptosis, drooping of the upper eyelid. The disease has three degrees:

the first - the eyelid covers one third;
the second - covers more than half of the pupil;
the third - the pupil is completely covered.

Ptosis occurs due to weakened muscles

Ptosis is a pathology that occurs after a malfunction of the muscles that lift the eyelids up, or their incorrect development. This disease manifests itself in both adults and children.

The disease manifests itself at birth or is acquired during life. Congenital ptosis is mainly observed bilateral. Occurs with underdevelopment of muscle tissue, or the complete absence of the eyelid lifting muscle.

The causes of such ptosis are: deviations from birth, heredity, pathologies during pregnancy or childbirth. This disease can cause strabismus and amblyopia.

Ptosis that is acquired during life may develop on one side of the face. Damage to the nerve fibers of the muscle occurs, the upper eyelid partially opens, or does not completely rise. The appearance of such ptosis is affected by:

acute pathologies of the central nervous system, which lead to partial immobility or paralysis of the muscle tissue of the eyelids;
stretching at the junction of the fibers of the muscle and tendon, or thinning of the muscle.

Ptosis has pronounced external symptoms:

one or both eyelids omitted;
eyebrows raised, expressing surprise;
the face becomes drowsy;
head in a tilted position;
it takes effort to close the eyes;
get tired quickly;
double vision;
irritation and redness of the mucous surface of the eyes.

What is ptosis, tell the video:

Ptosis classification

Acquired ptosis is classified into the following subspecies:

aponeurotic ptosis - muscle fibers are in a relaxed or stretched form, divided into:

involutional ptosis appears in people when natural wear and tear occurs, the withering of the whole organism and skin integuments;
ptosis resulting from the use of steroid drugs;
traumatic ptosis appears after an operation on the eye or muscle damage.

Neurogenic ptosis appears for reasons:

migraine - a consequence of ophthalmic diseases;
consequences of a stroke, multiple sclerosis;
a consequence of diabetic neuropathy, vasodilation
brain;
traumatic disorders of the central nervous system;
bacterial and viral lesions of this system;
pathology of the cervical nerve, working to lift the eyelids.

Mechanical ptosis occurs with a traumatic rupture of the eyelid, scars present on it, if there are adhesions of the eyelids or penetration of a foreign body into the eye area.
Myogenic (myasthenic) occurs in patients with myasthenia gravis (an autoimmune neuromuscular disease).
False ptosis (pseudoptosis) manifests itself in the form of:

extra formed folds of skin on the eyelid of the eye;
exophthalmos - protrusion of the eyeball;
decrease in elasticity.

Anophthalmic ptosis occurs when the organ of the eye is missing. The eyelid does not find support and falls.
Oncogenic ptosis is a consequence of tumor formations on the eye organ and in the orbit.

Diagnosis and treatment

Gravitational ptosis: stages

In this disease, the determining causes of its occurrence are first established. It is revealed what type of ptosis: acquired during life or received at birth. First, a conservative method of treatment is used, if there are no results, surgical intervention is used.

Diagnostics

At the first stage of the disease, the doctor finds out if there is a hereditary connection of this type of disease with diseases of relatives. Next, the state of the eye organ, visual acuity are revealed, all parts of the visual apparatus are examined, and the pressure inside the eye is measured.

Determine muscle tension. They do an MRI computed tomography heads to find out the causes of damage to the optic nerve - the engine of the eyelids.

The test is carried out using Tensilon's medicine according to the scheme. The injection is done intravenously, administering 2 mg. Then a break of 5 minutes to see the reaction to the medicine, and another 8 mg is administered.

If the lifting of the eyelids is restored, and the eye takes the correct position in the orbit, then this is considered a positive result. In this case, the disease is treatable.

Treatment

Ptosis can be corrected different methods

Treatment may be surgical intervention and with the operation. The first treatment is used when recovery of the affected nerve is possible. During treatment, the following methods are used:

ultra-high-frequency physiotherapy affects the sore spot with an electromagnetic field;
galvanotherapy is a method of using galvanic current;
the lowered eyelid is fixed with a plaster;
electrophoresis - this is physiotherapy that acts with the help of an electropulse current and medication on a sore spot.
laser therapy;
myostimulation - the impact of a low-power electric current on the muscles to strengthen them.

In addition, injections of Botox, Lantox, Dysport are used. The drugs relax the muscles responsible for lifting the eyelids. The eyelid rises, the position of the eye returns to normal, vision is restored. Injections are made at several points in the eyelid, the dose is determined by the doctor.

The procedure is painless and lasts five minutes. After injections, you must adhere to certain recommendations:

stay upright for several hours, do not bend over, do not lift weights;
do not massage, do not rub the injection site;
do not drink alcohol;
do not visit baths, saunas;
use heating bandages, compresses.

You need to stick to these recommendations for a week. The effect lasts from six months to a year. Surgical intervention becomes appropriate if the treatment does not give tangible results for a long time, and Botox injections are contraindicated.

With ptosis that occurs at birth, shorten muscle tissue. With ptosis acquired during life, the stretched aponeurosis of this muscle is shortened. After the operation, the positive effect persists for a long time.

The surgical method of treatment has three types:

The muscle tissue that performs the work of lifting the eyelid is sutured to the frontal muscle.
The muscle of the eyelid is attached to the superior rectus muscle (if it is not paralyzed).
Form folds on the tendon.

Gravitational ptosis

Ptosis can also occur in children

Ptosis, from the point of view of a cosmetologist, is affected by two reasons: the law of gravity and age-related changes. These two factors affect the loss of elasticity of the structures of the body, its tissues.

Earth gravity, or rather, its strength, affects the sagging of the body, skin, forms folds, wrinkles. The oval of the face is broken, it seems to be slipping. An important role is played by changes over the years.

The skin integuments lose their elasticity, firmness, become thinner, become dry. The corners of the mouth drop. There are different types of aging:

deformation type. It shows that the skin of the face is stretched, sagging cheeks, a second chin, lethargy.
The tired type occurs in thin women with an oblong face shape. Sunken eyeballs and cheeks, lowered corners of the mouth, lacrimal wrinkles deepen, tired and haggard appearance.
Fine wrinkled type. The face is tightened, the second chin does not appear, but there is a fine network of wrinkles.
Muscular type. The Mongoloid race is subject to this. On the face, the skin is elastic, there are no wrinkles.

Measures to combat and prevent ptosis

Preventive methods: gymnastic exercises for the face, strengthening the muscles of the eyelids, raising the general tone;
face massage; corrective masks.
Hardware methods: microcurrent therapy - stimulation with current; photothermolysis - rejuvenation with a laser beam.
Injection methods: botulinum therapy; fillers; plasmolifting (the most popular method); mesothreads.
Peelings.
Surgical methods: circular facelift; cosmetic plastic surgery of both eyelids; neck skin tightening.

In children, this disease can also be observed: congenital and acquired. It is especially important to cure it in children, since the child's body is growing all the time, the physique is being formed. Children undergo surgery at the age of three years and older.

Ptosis is not only a cosmetic problem, but also a possible deterioration in vision. The earlier the diagnosis is made and the treatment is carried out, the better the result.

Ptosis of the upper eyelid is a pathology in which the eyelid droops, which leads to partial or complete closure of the eye. This disease occurs in both adults and children.

The eyes are the main organ of vision in humans, and any pathological processes of an ophthalmic nature lead to visual impairment, and ptosis is no exception. To avoid serious complications, it is necessary to start treatment when the first symptoms of ptosis are detected.

Why does the eyelid droop?

What is ptosis, and what factors affect the skin of the eyelid, leading to its drooping? This is a disease that has a genetic predisposition, but often the pathology occurs due to injuries. Factors affecting the condition of the upper eyelid and leading to its drooping can be congenital and acquired.

Ptosis of the eyelid of a congenital nature is caused by the underdevelopment of the facial muscle responsible for the movement of the eyelid, or its complete absence. A child may already be born with a pathology of the structure of the upper eyelid, which may appear due to birth trauma or complications during pregnancy. As a rule, congenital drooping of the upper eyelid is accompanied by visual anomalies such as strabismus or the development of anisometropia.
The acquired type of ptosis of the upper eyelid develops due to a mechanical injury to the face or due to infectious diseases that have led to muscle deformation, such as neuritis or encephalitis. The causes of ptosis in the elderly are associated with natural, physiological processes in the body, muscles and ligaments gradually lose their elasticity, which leads to the development of eye pathology.

The application of mechanical injuries to the muscle that is responsible for the upper eyelid is one of the most common causes of the development of the disease. This is due to the fact that at the site of muscle damage, the tissue begins to scar, disrupting the natural process of raising and lowering the eyelid, and the muscle itself is too weak and unable to support it.

Types of pathology and degree of development

Ptosis, the causes of which can be congenital or acquired, is divided into three types, depending on the degree of damage to visual function.

By location, pathology can be:

unilateral (the upper eyelid falls on only one eye);
bilateral (both eyes are covered by the upper eyelids).

Ptosis can also be:

full - the eye is completely closed by the eyelid, a small gap remains;
incomplete - there is a slight omission of the outer corner of the upper eyelid (half-ptosis).

For the causes of the disease, it happens:

acquired;
congenital.

The disease develops gradually. At the first stage, there is a slight drooping of the eyelid, which covers the pupil by a third. If the patient does not pay attention to changes and does not carry out treatment, over time the eyelid begins to fall even more, and the disease passes into the second stage, which is characterized by half-closing of the pupil.

The eyes immediately react to the obstruction, unilateral strabismus begins to develop. Without timely treatment the pathology will begin to progress, and in the third stage of the disease, the eyelid will be completely lowered.

Vision begins to decline as the eyelid droops. Symptoms of pathology develop gradually. The patient begins to adapt to this pathology - throws his head back or constantly raises his eyebrow.

Physical manifestations of the disease

Symptoms of the disease develop as the upper eyelid begins to droop. On initial stages the development of the disease, a person does not notice any special changes in visual acuity, but there are physical signs of muscle dysfunction.

Eyebrow ptosis has the following symptoms:

a constant feeling of irritation in the eye, as if a mote had fallen;
eyes get tired too quickly, regardless of whether the eyesight is strained when reading and working at a computer or not;
permanently raised eyebrow;
a person often throws his head back;
visual impairment.

When blepharoptosis begins to develop, a person does not immediately pay attention to a change in the state of vision. The patient begins to reflexively tilt his head back or constantly raises his eyebrow to release the pupil. With the further development of the pathology, the symptoms appear more acutely.

Over time, difficulties arise in closing the eye, as the muscle weakens and is no longer able to perform its function. With constant irritation of the eye, infectious diseases can occur, further aggravating the patient's condition.

The manifestation of the disease is visible to the naked eye, at first the outer corner of the upper eyelid drops a little, as if it is inflamed, the facial expression immediately changes, it becomes boring, whiny.

In adults and children, the disease inevitably leads to visual impairment. Children develop strabismus, adults note a gradual decrease in visual acuity, double vision appears in the eyes.

Without timely treatment, pathology can lead to very serious complications and irreversible pathological processes, which are aggravated in the elderly.

What is ptosis?

Pathology that occurs over time and does not have a hereditary character is divided into several types depending on the reasons that led to its development.

Ptosis can be:

aponeuric;
neurogenic;
myogenic;
false;
mechanical.

The aponeuric type of pathology of the upper eyelid occurs due to muscle weakening, loss of elasticity and excessive stretching. This happens under the influence of many factors, and in most cases this pathology is observed in the elderly. Often, the weakening of the eyebrow muscle is associated with its injury or previous diseases, accompanied by an inflammatory process.

Ptosis of the neurogenic type appears after injuries that lead to a violation of the integrity of the muscle, past infectious diseases. Often this pathology is observed in patients who have had a stroke, or with the development of multiple sclerosis.

Treatment of ptosis of the upper eyelid of the neurogenic type must begin with the elimination of the cause of the pathology. There are cases when the drooping of the eyelid is caused by pathological processes in the cervical spine - a pinched nerve, the presence of a cancerous tumor that compresses the soft tissues.

The cause of the pathology of the myogenic species is the presence in a person of myasthenia gravis - a disease in which the myoneural synapse is affected. Mechanical ptosis appears due to a rupture of the eyebrow muscle.

There is the concept of false ptosis, the appearance of which is associated with the presence of excess folds in the upper eyelid, the presence of endocrine disorders in the body, or a decrease in intraocular pressure.

Ptosis that occurs as a result of the development of a neoplasm in the orbit is called oncogenic. In patients who do not have an eyeball for any reason, an anophthalmic-type pathology begins to develop over time.

Regardless of what caused the development of the pathology of the upper eyelid, treatment must begin with the elimination of the factor that led to the development of ptosis. If only a cosmetic defect is removed, the disease will return after a while.

Diagnostic methods

Ptosis, the treatment of which often leads to the need for a surgical operation, is diagnosed by an ophthalmologist when examining a patient. The doctor immediately sees the lowered upper eyelid, but in order to find out the cause of the pathology, the patient needs to undergo a series of medical tests.

Used for diagnostics modern methods examinations that allow not only to identify the cause of the pathology, but also to determine the degree of development of the disease and the presence of complications.

To clarify the primary diagnosis, the doctor will need a complete history of the patient, conducting a survey, during which the doctor finds out whether the patient had eye or head injuries, whether close relatives had a pathology of drooping of the upper eyelid.

The examination methods necessary to diagnose the causes of ptosis are:

magnetic resonance imaging;
computed tomography.

These methods make it possible to identify the causes of the pathology and to study the degree of development of complications that have arisen due to ptosis. Parents Special attention should be given to your children in the event that a slight drooping of the upper eyelid is noticeable.

It is worth remembering that such a symptom is the first and main sign of ptosis, and the sooner the diagnosis is made and treatment is started, the less likely it is that serious complications will occur.

Pathology therapy

Some patients, having noticed the first manifestations of ptosis in themselves, do not pay attention to it, believing that this pathology is only a cosmetic defect, and postpone treatment. But ptosis is a serious pathology of vision, which without timely and proper treatment will lead to very serious consequences, and it will be impossible to correct them.

In the early stages of the development of the disease, it is possible to use conservative methods of treatment aimed at restoring the elasticity and firmness of the eyebrow muscle. The method of treatment will depend on what cause led to the development of ptosis. The main methods of conservative treatment of ptosis are as follows:

UHF therapy;
electrophoresis procedures;
laser muscle tightening;
myostimulation method.

If treatment with conservative methods was carried out for ptosis of the upper eyelid, after a while the disease will again make itself felt. If, a few months after treatment, a person notices the manifestation of symptoms of the disease, it is necessary to carry out surgical operation. Innovative methods for the treatment of ptosis - the introduction of injectable drugs:

botox;
dysport;
lantox.

The essence of these techniques is the introduction into the eyelid of drugs that have a relaxing effect on the eyebrow muscle. As soon as the eyelid is raised, the patient's vision immediately improves.

Before performing the procedure, the doctor carefully examines the patient's history, in particular the presence of allergic reactions body for substances for injection. It is important to understand that these procedures, although they have a quick effect, do not affect the cause of the appearance of ptosis, and the disease may return after a while.

When conservative treatments fail to cure ptosis, the doctor prescribes surgery. The essence of the surgical intervention is that the patient's brow muscle is shortened, which has stretched and is no longer able to support the upper eyelid.

For the operation, general anesthesia or local anesthesia is used, the choice depends on how the patient tolerates medical manipulations. The duration of this operation to shorten the eyebrow muscle is 30-60 minutes. A week after the operation, the patient's stitches are removed, which will quickly heal and will not be visible.

There is the concept of gravitational ptosis, the appearance of which is due to the fact that the skin on the face begins to lose its elasticity and stretches, and with it the upper eyelids droop.

With this pathology, there is a displacement of the lower eyelid. This is the mildest type of ptosis, the treatment of which involves the use of various cosmetic methods - massages and application of creams - to restore skin tone and tighten the eyelids.

In advanced cases, when the skin has become completely decrepit, and creams are not able to restore its original state, hardware procedures, laser resurfacing, and plastic lifting are performed.

Ptosis is not a cosmetic defect, but a severe ophthalmological problem that, without proper treatment, can lead to irreversible pathological processes and subsequently to complete blindness.

It is impossible to delay treatment, it is necessary to consult a doctor when the first sign of ptosis appears - a slight drooping of the outer corner of the upper eyelid.

The asymmetry of the upper eyelid of one of the eyes in relation to the other is a reason to be wary. A similar symptom may indicate a disease such as ptosis. With this disease, a person not only looks older than he really is, but also tired and bleak. And all due to the fact that you have to exert enough strength to just blink, tilt your head to see well. In this article, we will analyze the causes and symptoms of ptosis of the upper eyelid, as well as talk about how to properly treat it.

What it is

Ptosis (blepharoptosis) is the drooping of the upper eyelid, which leads to a narrowing of the palpebral fissure. Normally, the upper eyelid covers the iris by about one and a half millimeters. When the eyelid closes the eye for two millimeters or more, this indicates ptosis.

The upper eyelid is lifted with the help of a muscle that can work normally if it receives nerve impulses along the oculomotor nerve canal. But if for some reason the nerve is damaged, then the impulse does not reach the muscle, which leads to the drooping of the eyelid.

Sometimes other pathologies are mistaken for ptosis. So, for example, the eyelid can drop due to its insufficient support by the eyeball, the same thing happens with ipsilateral hypotrophy, with eyebrow ptosis, dermatocholasis, and so on.

Causes

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

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

Causes of acquired blepharoptosis:

Injuries or diseases of the nervous system that lead to paralysis of the oculomotor nerves.
Full or partial lifting of 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 internal organs, diabetes, pathology of nerves.
Medical procedures performed on the face and eyes.

False ptosis appears due to hysterical state or nervous tick, strabismus, excess skin on the eyelid.

ABOUT age-related farsightedness read in .

Ptosis of the upper eyelid can be a sign of some serious disease, so you need to conduct a full examination to avoid unpleasant consequences.

Symptoms

The most important symptom of ptosis is the drooping of the upper eyelid, which can be unilateral or bilateral and has a different severity. A person who has a disease such as blepharoptosis is often forced to tighten the muscles of his forehead, raise his eyebrows and tilt his head back. All this he has to do in order to see better. In addition, it becomes difficult for a person to blink, which leads to fatigue, irritation and infectious diseases eye.

Inflammation of the conjunctiva of the eye, symptoms and causes, read.

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 superior rectus muscle of the eye (incomplete paralysis).

If the eye is permanently covered by the eyelid, this can lead to amblyopia (decreased visual function).

Additional symptoms of acquired ptosis:

(doubling of the image);
Exophthalmos (displacement of the eyeballs anteriorly);
Enophthalmos (deep position of the eyeballs);
Decreased 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 determine the cause, the doctor must:

Assess the position and mobility of the eyelid.
Assess the symmetry of eye movements.
Assess brow mobility.
Determine the size of the eyelid crease.
Determine the strength of the muscle that lifts the upper eyelid.
Determine the presence of strabismus.
Check your vision.
Measure intraocular pressure.

The ophthalmologist's vision check table is shown in.

The specialist should clarify with the patient 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, then the doctor should check the bone structures for damage. To do this, you need to conduct an overview x-ray. If there is a suspicion that ptosis appeared due to problems with the nervous system, then a computer or magnetic resonance imaging of the brain is performed, a referral is given to a neurologist and a neurosurgeon.

Treatment

It should be remembered that ptosis of the upper eyelid cannot disappear just like that. Surgery is required to cure this disease.

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

If ptosis was caused by a chronic disease, then first you need to eliminate this factor, and after that, carry out the operation. The operation is performed by an ophthalmic surgeon under local anesthesia. In the case of surgery in children,

general anesthesia. The procedure lasts on average about one and a half hours.

Stages of the operation:

Removal of a strip of skin on the upper eyelid.
Cutting of the orbital septum.
Separation of the muscular aponeurosis.
Removal of part of the muscle (shortening).
Muscle suturing to the cartilage of the eyelid.
Cosmetic suture.

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

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

It will not work to cure ptosis at home, the only exception is the age-related drooping of the upper eyelid. To do this, you can use various cosmetics that nourish and tighten the skin of the eyelids.

But don't expect quick results, especially if the ptosis is strongly pronounced.

Ptosis correction surgery. Before and after the procedure

Complications

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

. But it quickly passes with proper treatment.
Lachrymation, fear of light, visual disturbances, sagging eyelids. These complications are temporary and disappear fairly soon.
After surgery, asymmetry sometimes appears. It disappears over time, but sometimes it can be permanent.
Extremely rarely, ectropion of the eyelids can occur. It requires conservative treatment, sometimes another operation is needed.

The drooping of the upper eyelid (ptosis) is a pathologically incorrect position of this segment, which leads to covering the palpebral fissure. It should be noted that a drooping eyelid leads not only to an external cosmetic defect. Such a violation leads to increased fatigue of the organ of vision, eye irritation, and the development of other ailments.

The clinical picture of such a pathology is pronounced, therefore, as a rule, there are no problems with the diagnosis. Ptosis of the upper eyelid is treated only surgically, this pathology is considered not only in ophthalmology, but also in plastic surgery.

It is also noted that the pathology has no restrictions regarding age and gender, and therefore is equally diagnosed in both children and adults. Ptosis can be either congenital or acquired.

Congenital ptosis of the upper eyelid may be due to such etiological reasons:

absence or pathology of the levator muscle, which is responsible for lifting / lowering the eyelid;
pathology of the conductive pathways of nerve endings.

In addition, the development of blepharoptosis of the upper eyelid as a result of a family predisposition is not excluded. In more rare cases, the congenital form of the disease remains etiologically unidentified.

As for the acquired form of pathology, when one eyelid is lower than the other, the following etiological factors are present here:

the natural aging process of the body;
diseases of the nervous system - stroke, multiple sclerosis;
paresis of the oculomotor nerve;
meningitis;
brain tumors (and the cause can be both a malignant neoplasm and a benign one);
brain abscess;
Horner's syndrome;
myasthenia gravis;
muscular dystrophy;
blepharophimosis;
congenital myopathy;
eyelid tumors;
retebulbar hematoma;
mechanical damage to the organs of vision;
scarring after injury or serious illness.

Separately, it should be said about such a type of pathology as pseudoptosis. In this case, the eye closes due to an excessive amount of skin.

Classification

According to the nature of the occurrence, the following forms of the disease are distinguished:

congenital ptosis.
acquired ptosis.

By the nature of the lesion, they distinguish:

unilateral ptosis;
bilateral.

Based on the etiology of the pathological process, the following forms are distinguished:

neurogenic ptosis.
aponeurotic.
myogenic.
mechanical.
pseudoptosis (false).

Based on the severity of the pathological process, the following forms of the disease are distinguished:

ptosis I degree or partial - the edge of the eyelid covers only the upper part of the pupil;
ptosis of the second degree (semi-ptosis of the upper eyelid) - the segment descends to half of the pupil;
ptosis of the third degree or complete - in this case, the upper eyelid covers the entire pupil.

Clinicians note that in most cases the unilateral nature of the development of the pathological process is diagnosed ( about 69% of the time).

Symptoms

It should be noted that the congenital form of this disease is quite often combined with other ophthalmic diseases, due to the peculiarities physiological structure organ of vision.

In this case, the clinic of congenital or acquired ptosis is characterized as follows:

the patient is forced to throw his head back in order to ensure normal vision.
blinking movements are difficult.
increased eye fatigue.
frequent inflammatory processes.
irritability of the organs of vision.
decrease in visual acuity.
infection of the organs of vision, which significantly worsens the course of the clinical picture.

Due to the fact that one eye is constantly covered, over time, the patient develops amblyopia (impaired vision in one eye). The development of other ophthalmic diseases is also not excluded. Since clinical picture quite specific, problems with the diagnosis does not arise.

At the first symptoms, you should seek medical care and not ignore the signs of the course of the pathological process.

Diagnostics

At the initial examination ophthalmologist The following indicators are evaluated:

the size of the palpebral fissure;
eyelid localization height;
the location of the eyelids of both eyes;
symmetry of the organs of vision;
mobility of the eyes and eyebrows;
levator muscle strength;
head position.

Also during the physical examination, the clinician should determine the patient's personal and family history, the nature of the manifestation of additional symptoms (if any), the time when the first clinical signs began to appear.

In addition, the following diagnostic measures are carried out:

visual acuity tests.
perimetry.
biomicroscopy.
study of binocular vision.
measurement of the angle of strabismus.
exophthalmometry.
determination of the volume of accommodation.
CT or MRI of the brain.

It should be noted that with the acquired form, consultation may be required. neurosurgeon and neurologist.

Further therapeutic measures are determined based on the data obtained during the initial examination and the results. diagnostic measures. However, it should be understood that it is possible to correct the lowered corners of the eyes, in most cases, only by resection.

Treatment

The provoking factor is eliminated and only then the cosmetic defect. The treatment of ptosis is determined individually. In the case of a congenital form of pathology, the decisive method for eliminating the pathology is surgical intervention.

The time of the operation is determined individually, but there are general recommendations:

partial ptosis is eliminated by surgical intervention at the age of 13-16 years;
with complete ptosis, the operation is performed in preschool age. This is due to the fact that in this case the risk of developing amblyopia and other ophthalmic diseases is eliminated.

Regardless of what form of pathology is diagnosed and what method of intervention is chosen, the actions will be aimed at shortening the muscle or shortening the levator aponeurosis.

Standard resection of the levator eyelid is carried out as follows:

thin excess skin is excised.
aponeurosis resection.
the lower edge of the aponeurosis is fixed to the cartilage of the upper eyelid.

If we consider such an intervention from the point of view of plastic surgery, then quite often resection is carried out in conjunction with blepharoplasty.

In the event that a neurological cause for the development of such a pathology is established, then conservative methods for removing the pathology are initially used, namely:

massage;
galvanization;
paraffin therapy.

If within 6-9 months conservative measures do not give results, doctors prescribe an operation.

Forecast

With the right tactics of surgical intervention, the aesthetic result is preserved for life. If treatment is not started, over time, the patient develops amblyopia and other irreversible ophthalmic diseases. All this can lead to complete loss of vision.

Possible Complications

The most likely aggravating factors include:

unilateral amblyopia.
diplopia.
strabismus.
chronic ophthalmic diseases of an infectious nature.

To prevent such complications or reduce the risk of their development is possible only if you consult a doctor in a timely manner.

Prevention

Regarding the congenital form of pathology, there are no specific methods of prevention. As for the acquired type of the disease, it is advisable to use the following recommendations of clinicians:

prevention of eye injuries;
timely and proper treatment ophthalmic diseases;
prevention of neurological diseases, as they are one of the causes of this pathological process.

Persons who have a family history of chronic ophthalmic diseases should systematically undergo a preventive examination by a doctor. Self-medication is excluded, as this is fraught with the development of extremely negative consequences.

Many people consider ptosis a non-serious disease: it does not threaten life, does not cause serious complications, and is rather a cosmetic defect. However, eyelid drooping can cause various psychological problems, and in advanced cases - lead to severe deterioration and even loss of vision.

Description and classification of ptosis

Some parts of the human body can change their location - fall. If in the case of the kidneys or breasts this happens almost imperceptibly, then the drooping of the eyelids is visible to the naked eye. This disease is called ptosis, which in Greek means "fall".

The problem can be observed both in adults and in children, including infants. To babies, this defect is most often transmitted from parents, being hereditary. In adult men and women, ptosis occurs for various reasons: due to muscle paralysis, tumors, scars.

In older people, ptosis develops most often due to a decrease in skin elasticity and age-related changes. In youth, the border between the eyelid and the cheek is invisible, but over time, the subcutaneous fat covering the eye socket bone moves down, forming characteristic "bags" - ptosis of the lower eyelid appears. The tissues above the eyes also undergo changes. On the upper eyelid, an excess of skin forms, which shifts down, covering the iris. Age-related ptosis can be conditionally divided into 4 stages.

Ptosis only on the lower eyelids.
Drooping of both lower and upper eyelids.
Together with the eyelids, the tissues of the cheeks and cheekbones descend, and deep nasolabial folds form.
Lowering of the corners of the eyes, exposure of the sclera, the formation of a deep nasolacrimal groove.

Ptosis causes significant discomfort to both the elderly and young people. Young people are very complex because of their appearance, and old people, who often suffer from poor eyesight, have to strain a lot to see at least something with a half-closed eye. Often, patients are forced to tilt their heads back to increase the viewing angle, assuming a characteristic “stargazer pose”.

Depending on the cause of ptosis, it can be congenital or acquired. If a pathology is found in a newborn child, most often this indicates that one of his relatives already has such a disease. In addition, ptosis in infants may be associated with improper eye formation or underdevelopment of certain muscle groups. In this case, the disease is accompanied by reduced vision and.

Acquired ptosis has the following varieties:

neurogenic - occurs due to neurological problems;
mechanical - provoked by the shortening of the eyelid due to the appearance of a scar or tumor on it;
myogenic - is a complication of myasthenia gravis, which is characterized by disturbances in the work of striated muscles;
aponeurotic - appears due to the discharge of the tendon that lifts the eyelid from the place of its attachment due to injuries or age-related changes;
false - provoked by excess skin on the eyelid.

Eyelid ptosis can be either unilateral or bilateral. In the first case, only one eye is affected, and in the second, the disease progresses immediately on both organs of vision. As a rule, unilateral ptosis is more often acquired, while bilateral is a congenital pathology.

Elena Malysheva about ptosis - video

Causes and symptoms

Congenital and acquired forms of the disease appear under the influence of completely different causes.

Congenital ptosis occurs due to:

genetic predisposition;
underdeveloped muscle that lifts the upper eyelid;
pathology of the oculomotor nerve;
Gunn's syndrome, which is manifested by the drooping of the eyelid during the work of the masticatory muscles;
blepharophimosis, i.e. too narrow palpebral fissure.

The causes of acquired ptosis may be the following factors:

paralysis of the oculomotor nerve, which occurs with various tumors and diabetes;
chronic kidney and cardiovascular diseases;
fatigue of the muscles that raise the eyelids;
eye injury;
advanced age;
scars in the eye area.

The last reason is the result of operations or cosmetic procedures. So, ptosis often occurs after Botox injections and other interventions to rejuvenate the face.

The main sign of ptosis is the drooping of the upper or lower eyelid. Many other symptoms may also indicate an anomaly:

rapid fatigue of the organs of vision;
double vision;
irritation, redness and dryness of the eyes, a feeling of heaviness;
strabismus;
inability to lower or raise the upper eyelid.

Also, ptosis can be of varying degrees of severity. In the absence of treatment, the disease progresses quite quickly from partial to complete drooping of the eyelid.

Degrees of ptosis - table

When the first signs of eyelid ptosis appear, you should not hesitate to visit a doctor. Timely treatment can return the patient previous view without the use of surgical methods of correction.

Diagnostics

The symptoms of ptosis are so vivid that the patient can make a diagnosis on his own. You need to consult a doctor so that the specialist establishes the cause of the pathology and prescribes the appropriate treatment.

Before the examination, a conversation is held with the patient, on the basis of which the doctor concludes whether the pathology is congenital. The course of treatment can also be affected by the presence of other diseases in a person, therefore, the specialist’s duties also include compiling a complete picture of the patient’s health, because this defect is rarely an isolated pathology. For example, if we are talking about acquired myogenic ptosis, the patient should have myasthenia - chronic weakness muscles, which the patient simply cannot not know about.

After collecting an anamnesis, the doctor conducts an examination of the patient, which includes:

measurement of visual acuity and angle of strabismus;
determination of intraocular pressure;
visual examination to determine the weakness of the muscle responsible for lifting the eyelid;
measurement of the height of the upper eyelid;
establishment of muscle tone;
observation of the symmetry of eyelid movements during blinking.

If the doctor decides that the ptosis is caused by oculomotor nerve palsy, he may order an ultrasound of the eyes, x-rays of the eye socket, as well as magnetic resonance and computed tomography of the brain. These studies make it possible to identify neurological disorders and develop a treatment plan taking into account the identified pathologies.

Treatment

Most often, drooping eyelids are eliminated surgically, but in some cases conservative treatment is also effective. As a rule, the doctor prescribes it if the cause is age-related changes or in cases where the patient is diagnosed with an acquired neurogenic type of disease.

conservative

Non-surgical treatment of ptosis is a rather lengthy process, and it can be achieved with its help positive result is not always possible. Therefore, doctors prescribe such procedures only in case of firm confidence in their effectiveness for a particular patient.

Conservative treatment consists in the use of the following methods.

The use of pull-ups. Creams and ointments with a lifting effect are prescribed in cases where the cause of ptosis is the advanced age of the patient. Such remedies help only in case of partial ptosis. If the eyelid covers more than half of the pupil, they will not give a pronounced effect. You need to apply a tightening cream daily, without gaps, and before starting treatment, you should test the drug, since people prone to allergies may experience unwanted reactions to such products.
Massage. Regular therapeutic massage helps to strengthen the muscles of the eyelids, but it is most often useless with pronounced ptosis.
Fixation of the eyelid with a plaster. This measure is also aimed at strengthening the muscles of the upper eyelid and is effective only in the initial stages of the disease. Doctors rarely prescribe such a procedure, because it causes additional discomfort to patients, both physical and psychological.
UHF therapy. Treatment with a high-frequency electromagnetic field is very effective for neurogenic ptosis, when it is necessary to restore nerve function.
Galvanization. Local application of a low current also makes it possible to achieve improvements in the treatment of neurogenic ptosis, but is ineffective in the case of other types of this disease.
Paraffin therapy. Paraffin masks are used to tighten the muscles of the face and are effective at the stage when ptosis is not yet pronounced, but pathological process already started. Apply them 1-2 times a week until the desired effect is obtained and 2-3 times a month for preventive purposes.
Eye exercises. With the help of myogymnastics, you can tighten and strengthen the muscles of the face. For this, various exercises are used: opening and closing the eyes, circular rotations, bringing the eyebrows together while fixing them with your hands. Such gymnastics is very effective as preventive measure, however, a significant improvement with its help is extremely rare.
Taking medication. If ptosis is a complication chronic diseases, including neurological, treatment is reduced to eliminating the cause of the disease. In this case, a neurologist or other specialist, along with physiotherapy, may recommend taking appropriate medicines. Ptosis will disappear on its own after the disease that caused it is eliminated.

With the ineffectiveness of conservative methods, ptosis is eliminated with the help of surgery.

Surgical methods of correction

In most cases, surgery is used to treat ptosis. Surgery justified in the following cases:

in the treatment of children (over three years old);
to eliminate congenital omission of the eyelid;
in advanced cases, when the eyelid covers more than half of the pupil;
for the fastest possible results.

In the case of blepharoplasty, the eyelids acquire a normal appearance immediately after the operation, and the effect persists for a long time. Timely surgical intervention is especially important if a child suffers from ptosis. In babies, the organs of vision are just being formed, and drooping eyelids can have a negative effect on them, provoking strabismus and other problems. Therefore, for children who are already 3 years old, ptosis is most often eliminated surgically, without resorting to conservative treatment.

There are several types of operations to eliminate the omission of the eyelid.

Hemming to the frontal muscle - is carried out with insufficient mobility of the upper eyelid.
Resection of the muscle - is performed with moderate mobility of the eyelid and shortening of the muscle, which does not allow it to fall. The surgeon makes an incision in the eyelid, removes a small area of skin, and cuts off part of the muscle.
The imposition of a duplication of the aponeurosis of the muscle is carried out with good mobility of the upper eyelid. To raise it, it is necessary to shorten the muscle that controls the eyelid.

As a rule, operations are performed under local anesthesia, the stitches are removed on the 3-5th day, and the rehabilitation period does not cause significant inconvenience to patients. With a properly performed intervention, relapses of ptosis rarely develop, and a person can return to their usual way of life. The choice of a clinic and a specialist who will perform the operation should be approached very carefully, because the unprofessional actions of a doctor can provoke a number of complications: lacrimation, eversion of the eyelid, sloppy scars, etc.

Feedback on the operation

I am 16 years old, I have congenital ptosis, I had 5 operations at the Fedorov polyclinic in Novosibirsk (I live in Magadan). I vaguely remember the first 4 operations, because I was very small, but thanks to them, my ptosis is not very noticeable. I can open my eyes wide, but at the same time I don’t open them with the eyelid muscle (it doesn’t work), but I don’t even know how to explain it ... With the muscles of the eyebrows, something like that. With makeup, ptosis is even less noticeable. I'm suffering. It's still a complex, but what. I can't deal with the fact that I've been like this all my life...

Morgan le Fay

My son is also 3 years old, in July we performed an operation on him in Ufa, at the All-Russian Center for Eye and Plastic Surgery. We had ptosis, one eye - 2, the second - 3 degrees, after the operation, the eyes became wider, more open and there was no forced position of the head up.

Hope

http://www.woman.ru/beauty/plastic/thread/4045387/

My son has congenital ptosis of both eyes of the 4th degree. Surgical treatment passed at the age of 2 years, made a resection of the levator. The operation lasted about 2 hours under general anesthesia. The result was not impressive: the right eye was opened halfway, the left - a little less. But we have a serious neurology, now the child is almost 6 years old, and I can say that the more he develops, the better his eyes open, that is, there is an obvious connection between the general improvement in the neurological status of the child and the opening of the eye. It probably improves overall nerve conduction, hence the wider eyes.

http://eka-mama.ru/forum/part56/topic271358/

Folk remedies

Treatment with herbs and others folk methods does not bring a noticeable effect when lowering the eyelids and is justified only as a preventive procedure or as an additional remedy in parallel with traditional therapy.

The following recipes help to tighten and strengthen the skin of the eyelids at home:

Grated raw potatoes. Grate a potato on a fine grater, put it in the refrigerator for 30 minutes, and then apply the mass on clean eyelids. Leave the mask on for 15 minutes, then rinse it off with warm water.
Chamomile and thyme. Pour 2 tablespoons of chamomile or thyme herb with a glass of boiling water and cook in a water bath for 15-20 minutes. After the broth has cooled, they need to wipe the eyelids and face.
Rosemary and lavender. Pour 1 tablespoon of lavender and rosemary into a thermos, pour 0.5 liters of boiling water and leave for 3-4 hours. With a cooled infusion, wipe your eyelids 3 times a day.
Ice cubes. To improve skin elasticity, it is useful to wipe your face with ice cubes - you can freeze cucumber juice, a decoction of birch leaves or chamomile infusion.
Sesame oil and egg yolk. Beat the yolk of 1 egg, add half a teaspoon of sesame oil, mix well and apply the mixture on the eyelids. Wash off the mask with warm water after 20-30 minutes.

Regular use folk remedies can delay age-related ptosis for a while.

Folk remedies for the prevention of ptosis in the photo

Potato contains starch, which has a positive effect on sagging skin
Chamomile - recognized antiseptic
Thyme is used to treat many diseases, as well as to prevent ptosis. Rosemary tightens the skin of the eyelids Lavender is both cosmetic and medicinal raw material. Ice cubes cool the skin, making it firmer Yolk and sesame oil - base nourishing mask for eyelids

Prognosis and possible complications

Eyelid ptosis is successfully treated surgically, but conservative methods may not bring the desired results. In this case, you should not postpone surgery, since omission of the eyelid can provoke such ailments as strabismus and amblyopia, which leads to a significant deterioration in vision.

Sometimes the operation does not bring results. If, after the intervention, a person has a persistent complete ptosis of one or both eyes, this is the basis for obtaining a disability.

The operation does not always go smoothly. Most often, after the intervention, patients experience the following complications:

soreness of the eyelids;
loss of sensation;
dryness and pain in the eyes;
lacrimation;
slight asymmetry of the eyelids
swelling and inflammation of the skin around the eyes;
inability to completely close the eyelids.

As a rule, most complications go away after 1-2 weeks. If the symptoms continue to bother, the patient needs further examination and treatment.

Prevention

The following measures can help prevent ptosis:

Timely treatment of diseases that lead to drooping of the eyelid (in particular, the elimination of problems with the facial nerve).
Myogymnastics for the eyes and facial muscles.
Facial massage, including independent.
Usage folk recipes for tightening the skin of the eyelids.
Regular use of masks, creams and serums with a lifting effect to prevent age-related changes.

At the first signs of ptosis, consult a doctor immediately. In the early stages, droopy eyelids can be treated without surgery.

Eyelid prolapse prevention exercises - video

Eyelid ptosis causes people a lot of inconvenience, both physical and psychological. In some cases, this problem can be eliminated by conservative methods, but more often the case ends with an operation, especially in the congenital form of the disease. Do not be afraid of surgical intervention: subject to a competent choice of a specialist, the operation will return you an attractive appearance, A possible complications will be kept to a minimum.