What Is Eyelid Ptosis?

Blepharoptosis usually refers to drooping of the upper eyelid, which manifests as the upper eyelid is partially or completely unable to lift, causing the lower edge of the upper eyelid to cover the upper edge of the cornea so much that the cracks in the affected eye appear smaller than normal. Patients often raise eyebrows, wrinkle forehead, and raise their heads to form a special staring posture. If this disease occurs from an early age, the pupils are covered for a long time, and it is easy to become amblyopia. Eyelid droop is an early symptom of many diseases and should be diagnosed as early as possible and treated for the cause. Congenital ptosis should be corrected surgically.

Basic Information

English name

blepharoptosis

Visiting department

Ophthalmology

Common locations

Upper eyelid

Common causes

Oculomotor nucleus hypoplasia, or oculomotor nerve palsy, trachoma, tumor, inflammation and trauma, eyelid hypertrophy, injury to levator levator muscle, etc.

Common symptoms

The upper eyelid cannot be raised partially or completely

Causes of eyelid droop and common diseases

Causes of drooping eyelids are numerous and involve neurology, ophthalmology, and endocrinology. Eyelid droop is clinically divided into congenital and acquired. Congenital, from the birth of the eye does not open, belongs to the branch of the occipital levator muscle of the oculomotor nerve, or caused by dysplasia of the oculomotor nerve nucleus, and hereditary. Acquired ptosis due to oculomotor nerve palsy, or trachoma, tumors, inflammation and trauma, hypertrophy of the eyelid, and damage to the levator levator. Drooping eyelids can affect both eyes, and can also be single eyes. The eyelids cover the pupils and cause difficulty in seeing. Occurrence of drooping eyelids in children is mainly congenital simple drooping eyelids, mandibular blink syndrome, myasthenia gravis, and trauma. The main causes of drooping eyelids in adults include myasthenia gravis, chronic progressive extraocular muscle paralysis, hyperthyroid ophthalmopathy, and intracranial aneurysm compression eyelid droop. Major causes of drooping eyelids in the elderly include degeneration of the aponeurosis of the eyes, myasthenia gravis, drooping eyelids after cerebral infarction, and diabetic oculomotor nerve palsy.

Differential diagnosis of eyelid droop

Eyelid slack

Eyelid relaxation syndrome, also known as blepharoplasty and atrophic eyelid droop, is a rare eyelid disease. It is characterized by recurrent eyelid edema in adolescents. The eyelid skin becomes thinner, elasticity disappears, wrinkles increase, and color changes. Lacrimal gland prolapse, ptosis, and shortened transverse diameter of palpebral fissure were complicated. Eyelid relaxation syndrome affects the appearance of the eyelid, which is the main reason for patients to request treatment. Understanding of its clinical manifestations and pathogenesis helps to adopt appropriate methods for treatment.

2. Eyelid eversion

It is an abnormal state where the edge of the eyelid leaves the eyeball and turns outward. In the lighter eyelid, the eyelid leaves, and in the severer eyelid, the conjunctiva is exposed. Care should also be taken to distinguish between congenital and acquired eyelid droop.

Eyelid droop examination

1. Measure the height of the eyelid

The height of palpebral fissure in China is 7.41 8.92mm. Due to different ages, the height of palpebral fissure and the relationship between eyeballs are very different.

2. Determination of upper levator muscle function

The patient is required to open his eyes and stare forward and gaze upwards and downwards, measure the height of the eyelid fissure, and observe the relationship between the eyelid fissure and the eyeball. The duration of upper eyelid lifting was recorded to determine the function of the upper levator muscle. In order to avoid the impact of the forehead and frown muscle when the eyelid split is large, the patient's eyebrow arch should be squeezed with both thumbs during the examination, and then the patient should look in all directions to record the height of the eyelid split. If the upper eyelid cannot be lifted at all, it is completely sagging, and if it is slightly lifted, it is not completely sagging. Before surgery, the patient should look at the pictures in all directions for reference.

3.Tensilon test

If myasthenia gravis is suspected, a Tensilon test should be performed. If end-of-day sagging worsens and the patient is elderly, there may be senile sagging and muscle weakness at the same time.

Eyelid drooping treatment principles

Caused by diabetes

After the diagnosis, the patients were given timely treatment of hypoglycemic, nutritional nerves and activating blood.

2. Caused by intracranial aneurysm

It is unilateral, sudden drooping eyelids, and pupils dilated. If accompanied by severe headache, vomiting, convulsions, coma, etc., it is likely that the subarachnoid hemorrhage caused by aneurysm rupture should be immediately treated by the hospital neurologist.

3. Caused by brainstem lesions

The patient had drooping eyelids on one side, dilated pupils, and numbness and weakness in the upper and lower limbs on the other side. Brain stem tumors are common in children, and cerebrovascular disease is common in the elderly. MRI can confirm the diagnosis.

4. Caused by myasthenia gravis

Eyelid sagging develops slowly, starting with one eye and then with the other eye. The clinical symptoms were mild in the morning and dusk, and there were obvious fluctuations in one day. The neostigmine test, repeated electrical stimulation, and acetylcholine receptor antibody assays confirm the diagnosis. Immunosuppressive therapy should be actively used after diagnosis, and surgery should be evaluated in patients with thymoma.

5. Congenital Eyelid Sagging

Should be corrected surgically. At birth, drooping eyelids can be found, most of which are unilateral or bilateral. With age, this eyelid is only suitable for surgical correction.