What Is Palpebral Ptosis?

Ptosis refers to insufficiency or loss of the levator muscle and smooth muscle of the Müller, so that the upper eyelid appears partially or completely sagging. The lighter covers part of the pupil. In severe cases, the pupil is completely covered. Congenital ones can also cause amblyopia. . In order to overcome the visual impairment, the person with bilateral sagging needs to look up at the object to form a special posture of raising his head and wrinkles.

Basic Information

English name: ptosis
Visiting department: Ophthalmology
Common locations: Eyelid

Common causes: Insufficiency or loss of levator muscle and smooth muscle of Müller
Common symptoms: The upper eyelid appears to be partially or completely drooping, the lighter ones cover part of the pupils, the severe ones are all covered, the head is wrinkled, and congenital persons can also cause amblyopia.

Causes of ptosis

Congenital

Most of them are caused by hypoplasia or defect of the levator muscle, or due to innervation of the levator muscle. It is a congenital malformation, mostly bilateral, sometimes unilateral, and can be autosomal dominant or recessive.

2. Acquired

There are four reasons for this: traumatic, neurogenic, myogenic, and mechanical. Among them, myogenic ones are more commonly caused by myasthenia gravis.

3. Rickety

It is caused by rickets. Sudden drooping of the double upper eyelids or accompanied by ricky pupil dilation, sometimes the pressure on the orbital nerve can make the droop disappear suddenly.

Clinical manifestations of ptosis

Paralytic ptosis

Caused by oculomotor nerve palsy. Mostly monocular, often combined with oculomotor innervation of other extraocular or intraocular muscle paralysis.

2. sympathetic ptosis

It is due to dysfunction of Müller muscle or damage to the sympathetic nerve of the neck. If it is the latter, ipsilateral pupil reduction, invagination of the eyeball, facial flushing, and no sweat, etc., are also known as Horner syndrome.

3. Myogenic ptosis

More common in myasthenia gravis, often accompanied by the phenomenon of easy muscle fatigue in the whole body. The characteristic of this drooping eyelid is that it improves after rest, and immediately worsens when the eye blinks continuously, light in the morning and heavy in the afternoon, and neostigmine is injected subcutaneously or intramuscularly, and the symptoms are temporarily relieved after 15-30 minutes.

4. Other

(1) Traumatic injury to the oculomotor nerve or levator muscle and Müller muscle can cause traumatic ptosis.

(2) Diseases of the eyelid itself, such as severe trachoma and eyelid tumors, cause the eyelid to increase in weight and cause mechanical ptosis.

(3) No eyeballs, small eyeballs, eyeball atrophy, and various causes lead to a decrease in orbital fat or orbital contents, which can cause pseudoptosis.

Ptosis

In order to estimate the function of the upper eyelid muscle, the position of the upper eyelid margin when the eyeball is staring up and down can be measured under the premise of offsetting the contraction force of the frontal muscle. If the difference between the front and back is less than 4mm, it means that the levator muscle function is severely insufficiency.

Diagnosis of ptosis

Diagnosis is based on typical clinical symptoms.

Ptosis treatment

Mainly to prevent vision loss and improve appearance, treatment should be directed at the cause. Congenital ptosis should be corrected early if it affects vision development. If it is mild ptosis, does not affect vision development, elective surgery can improve appearance. Those with unilateral drooping and obstructing the pupil should strive for early surgery. The best time for surgery is before the age of 6 to prevent the formation of amblyopia. For myogenic or paralytic ptosis, adenosine triphosphate, vitamin B ₁ or neostigmine can be applied. Careful consideration should be given to surgery when Jiuzhi fails.

Prognosis of ptosis

For congenital blepharoptosis, early surgery can expose the optic axis and promote the normal development of vision. There is a regression phenomenon after surgery. If necessary, a second surgery is feasible.