Ptosis (drooping) of the upper eyelid Ptosis of the eyelids is a descent of more than 2 mm relative to the edge of the iris. Normally, the fold closes the iris by 1.5 mm or less, if the indicator is more or one eyelid is significantly lower than the second, they talk about pathology. The disease can occur in people of any age.
The asymmetry of the size of the eyes is visually noticeable. The defect often causes a decrease in vision. Treatment is aimed at increasing muscle tone.
Lower eyelid ptosis is much less common. In the early stages of the development of pathology, swelling and bags under the eyes are noticeable. With advanced disease, the edges of the fold that separate from the eyeball, which leads to eversion.
Causes of occurrence
Correct diagnosis of the causes of ptosis of the upper eyelid allows the doctor to choose an adequate strategy for combating pathology with a therapeutic or surgical method.
Among the reasons:
- paralysis of the oculomotor nerve;
- weakening of the muscles;
- pathology of the autonomic nervous system;
- the consequences of operations;
- incorrect therapy with botox injections;
- diabetes;
- endocrine diseases;
- ophthalmic diseases.
Types of drooping eyelids
- Depending on the cause of the appearance, there is the following classification of ptosis of the eyelid by form:
- Aponeurotic – stretching and weakening of muscles, loss of tone. It can arise as a complication after plastic surgery for a facelift, with the introduction of botulinum toxin preparations by a non-professional specialist and in violation of the technology, or with too frequent and prolonged use of Botox.
- Mechanical – muscle damage after injury, scarring, growth of tumor formation, which, due to the severity, does not allow the eyelid to stay in a normal position.
- Neurogenic – a pathology of the passage of a nerve impulse that controls a muscle. It is necessary to examine the brain to exclude diseases of the central nervous system (meningitis, neuritis, sclerosis).
- Age-related ptosis of the upper eyelid – aging of the body provokes stretching of muscles and ligaments, their weakening.
- False – with anatomical features (large fold volume), strabismus, hypotonia of the eyeball.
- Distinguish between acquired and congenital ptosis of the upper eyelid.
Features of congenital pathology
- In the presence of Horner’s syndrome, prolapse combined with a narrowing of the pupil, a decrease in sweating on the face, and a deeper location of the eyeball.
- Ptosis occurs in Marcus-Gunn syndrome when prolapse disappears when you open your mouth, yawn, or chew food.
- The defect occurs in Duane’s syndrome (a form of strabismus), in which the nerves that move the eye are impaired.
- Isolated ptosis often inherited. The disease characterizes by abnormalities in the development of the levator, tendon. The cause may be congenital myasthenia gravis, paresis of the cranial nerves.
Characteristics of acquired ptosis
The problem occurs as a result of injuries, tumors, age-related changes, as well as stroke, which causes paralysis of the levator (facial nerve).
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The possible complication with excessive use of botulinum toxin preparations or violation of technology. The muscles paralyzed by Botox do not provide lymph drainage, fluid accumulates, pulls the tissue down – the eyelid drops. Such a problem can arise with individual intolerance to the drug and the unprofessionalism of the cosmetologist.
There are several stages of pathology:
- partial ptosis of the upper eyelid (1 degree) – 1/3 of the pupil closed;
- incomplete ptosis of the upper eyelid (grade 2) – closed from half to 2/3 of the pupil;
- full (grade 3) – the pupil is completely close.
One eyelid can be omitted or both. At the first degree of ptosis of the eyelids, a person does not feel discomfort. With incomplete and complete omission, the following symptoms may occur:
- difficult to blink;
- the eye does not close completely – the mucous membrane dries up, irritation appears;
- the sensation of grit, as if sand were poured into the eyes;
- type of everted mucous membrane;
- frequent conjunctivitis;
- headache, eyes.
With advanced pathology, vision impairment, double vision, squint occur. With neurological ptosis of the upper eyelid, the eyeball sometimes sinks in, and the size of the pupil may change.
Diagnostics
To prescribe treatment, it is necessary to determine the root cause of the disease. In the early stages, the prolapse is almost imperceptible. The doctor finds out whether it is congenital or acquired ptosis in order to rule out brain diseases. If the patient cannot remember when the problem arose, the specialist prescribes additional tests.
Diagnostic steps:
- inspection, determination of the degree of omission;
- checking the acuity and fields of vision, the pressure inside the eye, examination of the bottom;
- biomicroscopy of the eye;
- checking muscle tone, blinking function;
- ultrasound examination, electromyography;
- radiography;
- MRI of the brain;
- check for binocular vision;
- consultation with a neurosurgeon, endocrinologist, neuropathologist.
Treatment features
After finding out the reasons, the doctor selects an adequate treatment. If congenital pathology is detected in the early stages, if vision may not impaired, comprehensive prevention is sufficient. To treat ptosis of the upper eyelid, conservative methods are used – without surgery – or surgical interventions are performed. If the problem occurs after injury or nerve damage, it is recommended to wait 1 year. During this time, the correct treatment is able to restore the nerves to work without surgery.
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Many people are interested in whether it is possible to remove ptosis of the upper eyelid with threads. Non-surgical methods of blepharoplasty with threads give good results for drooping eyelids. Rehabilitation lasts 2 weeks, and the result lasts for a long time. The finest biocompatible threads create a strong framework and provide support for weakened tissues.
Treatment of prolapse after “Botox”
The drug, which obtains from botulinum bacteria, used to disrupt the passage of nerve impulses to the muscles, to completely relax them. Inaccurate or incorrect insertion can lead to problems.
Experts recommend waiting for the botulinum toxin to stop working. This can take from 2 weeks to six months. To improve the situation and not wait long, therapy when performed. Elimination of blepharoptosis may performed using physiotherapy: massage, electrophoresis, UHF, microcurrents. Also appointed the introduction of “Proserin”, vitamin B, neuroprotective agents. Such treatment of ptosis of the upper eyelid after “Botox” contributes to the rapid resorption of the drug.
Surgical intervention
An operation to eliminate prolapse is prescribed at an advanced stage when the quality of vision may impaired. The intervention is performed under local anesthesia in an outpatient clinic. The procedure consists in shortening the relaxed muscle by cutting or removing part of it. The muscle also folded and stitched. The seam hidden in a natural fold of the skin, after a while it dissolves, or the seam removed after 3-5 days. Rehabilitation lasts 1 month, the patient monitored by a surgeon. Surgical treatment has a favorable prognosis – the patient gets rid of the defect for life, the risk of complications is minimal.