Absence of a fold in the upper eyelid in a child. What is congenital ptosis and how to treat it. Video - Ptosis: drooping upper eyelid

Ptosis of the eyelid, or blepharoptosis, is a drooping of the upper eyelid in relation to the edge of the iris by more than 2 mm. It is not only a cosmetic defect, but can be a symptom of a certain pathology and lead, especially in children, to a persistent decrease in visual acuity.

Symptoms and Classification of ptosis and the occurrence of ptosis of the upper eyelid

The main symptoms are:

visually noticeable blepharoptosis;
sleepy facial expression (with bilateral lesions);
formation of forehead skin wrinkles and slight eyebrow lifting when trying to compensate for ptosis;
rapid onset of eye fatigue, a feeling of discomfort and pain when straining the organs of vision, excessive tearing;
the need to make an effort to close the eyes;
over time or immediately occurring strabismus, decreased visual acuity and double vision;
“Stargazer pose” (slightly throwing the head back), especially characteristic of children and being an adaptive reaction aimed at improving vision.

The mechanism of development of these symptoms and ptosis itself is as follows. The motor functioning of the eyelid and the width of the palpebral fissure depend on the tone and contractions:

The levator of the upper eyelid (lifting muscle), which controls the vertical position of the latter;
The orbicularis oculi muscle, which allows you to close the eye steadily and quickly;
The frontalis muscle, which promotes contraction and compression of the eyelid with maximum upward gaze.

Tone and contraction are carried out under the influence of nerve impulses arriving to the circular and frontal muscles from the facial nerve. Its nucleus is located in the brainstem on the corresponding side.

The levator palpebrae superioris muscle is innervated by a group of neurons (right and left bundles of the central caudal nucleus), which are part of the nucleus of the oculomotor nerve, also located in the brain. They are directed to the muscles of their own and the opposite side.

Video: Ptosis of the upper eyelid

Classification of ptosis

It can be bilateral and unilateral (in 70%), true and false (pseudoptosis). False ptosis is caused by excess volume of skin and subcutaneous tissue, eyelid hernia, strabismus, decreased elasticity of the eyeballs and, as a rule, is bilateral, with the exception of unilateral endocrine pathology of the eye.

In addition, a distinction is made between physiological and pathological drooping of the eyelids. The above groups of nerves are associated with the sympathetic nervous system, the retina, the hypothalamus and other structures of the brain, as well as the frontal, temporal and occipital regions of the cerebral cortex. Therefore, the degree of muscle tone and the width of the palpebral fissure in the physiological state are in close relationship with the emotional state of a person, fatigue, anger, surprise, reaction to pain, etc. Blepharoptosis in this case is bilateral and is unstable, relatively short-term in nature.

Pathological ptosis occurs with injuries or inflammatory processes of the eyeball or muscles that move the eyelid, with inflammatory processes of the meninges and with disorders at various levels (nuclear, supranuclear and hemispheric) in the conductive nervous system with infarctions and brain tumors, disorders of sympathetic innervation and transmission of nerve impulses to muscles, in case of damage to the upper roots of the spinal cord, damage to the brachial plexus (plexopathy), etc.

Depending on the degree of the pathological condition, there are:

Partial ptosis, or degree I, in which 1/3 of the pupil is covered by the upper eyelid.
Incomplete (II degree) - when half or 2/3 of the pupil is covered.
Full (III degree) - complete covering of the pupil.

Depending on the cause, blepharoptosis is divided into:

Congenital.
Acquired.

Congenital pathology

Congenital ptosis of the upper eyelid occurs:

With congenital Horner's syndrome, in which ptosis is combined with constriction of the pupil, dilation of the conjunctival vessels, weakening of sweating on the face and a barely noticeable deeper location of the eyeball;
With Marcus-Hun syndrome (palpebromandibular synkinesia), which is a drooping eyelid that disappears when opening the mouth, chewing, yawning, or moving the lower jaw to the opposite side. This syndrome is a consequence of a congenital pathological connection between the nuclei of the trigeminal and oculomotor nerves;
With Duane's syndrome, which is a rare congenital form of strabismus, in which there is no ability to shift the eye outward;
As isolated ptosis caused by the complete absence or abnormal development of the levator muscle or its tendon. This congenital pathology is very often inherited and is almost always bilateral;
With congenital myasthenia or anomalies of levator innervation;
Neurogenic etiology, in particular with congenital paresis of the third pair of cranial nerves.

Video: Congenital ptosis of the upper eyelid in children

Congenital ptosis of the upper eyelid in children

Acquired ptosis

Acquired ptosis, as a rule, is unilateral and develops most often as a result of injuries, age-related changes, tumors or diseases (stroke, etc.), which result in levator paresis or paralysis.

Conventionally, the following main forms of acquired pathological condition are distinguished, which can also be of a mixed nature:

Aponeurotic

The most common cause is involutional age-related drooping of the upper eyelid as a consequence of dystrophic changes and weakness of the muscle aponeurosis. Less commonly, the cause may be traumatic injury or long-term treatment with corticosteroid drugs.

Myogenic

Occurring usually with myasthenia gravis or myasthenic syndrome, muscular dystrophy, blepharophimosis syndrome or as a result of ocular myopathies.

Neurogenic

It occurs mainly as a result of disturbances in the innervation of the oculomotor nerve - with aplasia syndrome of the latter, its paresis, Horner's syndrome, multiple sclerosis, stroke, diabetic neuropathy, intracranial aneurysms, ophthalmoplegic migraine.

In addition, neurogenic ptosis also occurs when the sympathetic pathway is damaged, which begins in the hypothalamic region and the reticular formation of the brain. Blepharoptosis associated with damage to the oculomotor nerve is always combined with pupil dilation and impaired eye movement.

A disturbance in the transmission of impulses from nerve to muscle often occurs, like its analogues (Dysport, Xeomin), in the upper third of the face. In this case, blepharoptosis may be associated with impaired function

ctions of the eyelid itself as a result of diffusion of the toxin into the levator. However, most often this condition develops as a result of local overdose, penetration or diffusion of the substance into the frontal muscle, its excessive relaxation and aggravation of the overhang of the skin fold.

Mechanical

Or completely isolated ptosis caused by inflammation and edema, isolated lesions of the levator, scars, a pathological process in the orbit, for example, a tumor, damage to the anterior part of the orbit, unilateral atrophy of the facial muscles, for example, after a stroke, significant tumor formation of the eyelid.

Blepharoptosis of the upper eyelid after blepharoplasty

It may be in the form of one of the listed forms or a combination of them. It occurs as a result of postoperative inflammatory edema, damage to the outflow pathways of intercellular fluid, as a result of which its outflow is disrupted and tissue edema also develops, damage to muscles or muscle aponeurosis, as well as hematomas that limit their function, damage to the endings of nerve branches, and the formation of rough adhesions.

How to treat this pathological condition?

Acquired ptosis of the upper eyelids

There are conservative treatment methods and various surgical techniques. Their choice depends on the cause and severity of the pathology. As a very short-term auxiliary method, correction of ptosis of the upper eyelid can be used by fixing the latter with an adhesive plaster. This method is used primarily as a temporary and additional method when it is necessary to eliminate complications in the form of inflammatory phenomena of the conjunctiva, as well as for complications after botulinum therapy.

Treatment of ptosis of the upper eyelid after Botox, Dysport, Xeomin

It is carried out by administering proserine, taking increased doses of vitamins “B 1” and “B 6” or introducing them in solutions by injection, performing physiotherapy (electrophoresis with a solution of proserine, darsonval, galvanotherapy), laser therapy, massage of the upper third of the face. At the same time, all these measures only slightly contribute to the restoration of muscle function. Most often it occurs on its own within 1-1.5 months.

Non-surgical therapy

Treatment of ptosis of the upper eyelid without surgery is also possible with false blephroptosis or, in some cases, the neurogenic form of this pathological condition. Correction is carried out in physiotherapy rooms through the use of the above physiotherapy procedures and massage. Treatment at home is also recommended - massage, gymnastics to tone and strengthen the muscles of the upper third of the face, lifting cream, lotions with an infusion of birch leaves, a decoction of parsley root, potato juice, treatment with ice cubes with an infusion or decoction of appropriate herbs.

Gymnastic exercises for ptosis of the upper eyelid include:

circular movement of the eyes, looking up, down, right and left with the head fixed;
open your eyes as much as possible for 10 seconds, after which you need to close your eyes tightly and tense your muscles for 10 seconds (repeat the procedure up to 6 times);
repeated sessions (up to 7) of rapid blinking for 40 seconds with the head tilted back;
repeated sessions (up to 7) of lowering the eyes with the head thrown back, holding the gaze on the nose for 15 seconds and followed by relaxation, and others.

It should be noted that all conservative treatment methods are mainly not therapeutic, but preventive in nature. Sometimes, in the first degree of the above forms of blepharoptosis, conservative therapy contributes only to a slight improvement or slowdown in the progression of the process.

In all other cases of pathological condition and with blepharoptosis of II or III degree, the use of surgical methods is necessary.

Ptosis of the upper eyelid is clearly visible when communicating with a person. This disease manifests itself in insufficient opening of the upper eyelid. The skin over the eyelid can hang at least 2 mm. Typically, a person diagnosed with upper eyelid ptosis looks older than his age. You might think about him that he is constantly tired or sad. This occurs due to defective vision. A person with ptosis must strain their facial muscles to blink normally. It is necessary to distinguish pseudoptosis from real pathology of the upper eyelid. With false ptosis, a narrowing of the palpebral fissure is observed due to a hysterical state or a nervous tic.

Causes

There are several reasons why there may be a violation of the structure of the eyelid in a child. The pathology can be congenital or acquired.

With congenital ptosis, there is an underdeveloped muscle of the upper eyelid, or its complete absence. This occurs due to genetic disorders.
If the fetus has neurological disorders during embryonic development, there is a possibility of underdevelopment of the oculomotor nerve.

There are many more reasons for acquired ptosis.

Diseases of the neurological system.
Sustaining an eye injury that causes optic nerve palsy. These nerves are responsible for the movement of the upper eyelid. Nerve palsy can be complete or partial.
Stretching of the skin of the eyelid due to deterioration of the body. In children, this can occur in the presence of chronic diseases.
Medical procedures are also the reason why a child may have ptosis of the upper eyelid.
It is possible that insufficient opening of the eyelid occurs due to the presence of dangerous diseases of the internal organs.

Symptoms

It is easy to determine pathological disorders of the eyelid in a child. This is noticeable visually without special examination. But there are several degrees of ptosis of the upper eyelid.

In the first degree of pathology, the upper eyelid covers 1/3 of the pupil. This degree slightly impairs the baby’s vision.
The second degree of ptosis is characterized by closure of 2/3 of the eyelid.
In the third degree, the pupil is almost completely covered by hanging skin. The child sees almost nothing with one eye.

It is difficult for a baby to blink with any degree of ptosis of the upper eyelid. He has to tense his facial muscles, including his eyebrows and forehead. The eye not only does not open completely, but also does not close if the pathology is congenital. Because of this, irritation of the eyeball occurs.

Diagnosis of ptosis of the upper eyelid in a child

The doctor will be able to determine the diagnosis during the initial examination. The doctor needs to diagnose ptosis and identify the exact cause of its occurrence.

During a visual examination, the doctor assesses the condition and mobility of the damaged eyelid.
It is necessary to compile an anamnesis. The doctor collects data about the baby’s family and takes into account hereditary factors.
The size of the hanging skin fold is determined.
The strength of the eye muscles is taken into account.
The doctor evaluates symmetry during eye movements, and the mobility of the eyebrows is also taken into account.
It is necessary to measure the child's intraocular pressure.
Children's visual acuity is assessed.
It is necessary to determine possible strabismus or amblyopia in the baby.

Congenital pathology can be distinguished from acquired pathology by the mechanism of pupil closure. With congenital ptosis, the eye will not be completely closed, unlike acquired ptosis. Depending on the cause of the disease, the necessary treatment will be prescribed to eliminate sagging skin above the eye.

Complications

How dangerous is eyelid ptosis for a child?

This pathology can negatively affect the baby's vision.
With ptosis of the upper eyelid, there is a risk of developing strabismus and amblyopia. Amblyopia is the formation of a “lazy eye”, which negatively affects visual function.
Also, hanging skin over the eye is a significant cosmetic defect.
Children from an early age can develop complexes about their appearance.
Experts do not reject the assumption that ptosis of the upper eyelid is transmitted by heredity.

Treatment

What can you do

Treatment of upper eyelid pathology in a child should not occur at home.
The doctor will determine how to treat ptosis in the baby, but surgical intervention is usually used.
Parents can help their child perform special procedures to eliminate the acquired pathology. But massage and therapeutic exercises will not be able to completely restore the affected eyelid without medical help.

What does a doctor do

The doctor will determine how to treat ptosis of the upper eyelid in a baby after making a diagnosis and finding out the exact cause of the pathology.

Surgery is used to completely eliminate the upper eyelid disorder.
But if the cause of ptosis is a disease, it must be treated first. After successful treatment, surgery can begin.
Before surgery, it is necessary to hold the affected eyelid with a plaster to prevent strabismus.
For children, the operation is performed under general anesthesia.
After removing excess skin and tightening the necessary muscles, the doctor applies a cosmetic suture.
After the operation, a bandage is applied to the eye, which can be removed after a few hours.
Bruises and swelling will disappear from the child’s face in one week.

Prevention

Acquired pathology in a child can be prevented by following treatment methods for diseases that contribute to drooping of the upper eyelid. Any ailments and pathologies that arise should be treated as soon as possible to prevent complications such as ptosis.

Protect your child from receiving eye herbs.
Congenital ptosis is difficult to prevent. During pregnancy, the expectant mother should lead a healthy lifestyle, eat right, protect herself from stressful situations and undergo regular examinations with a doctor.

You will also learn how untimely treatment of upper eyelid ptosis in children can be dangerous, and why it is so important to avoid consequences. All about how to prevent ptosis of the upper eyelid in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of upper eyelid ptosis in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat ptosis of the upper eyelid in children?

Take care of the health of your loved ones and stay in good shape!

Good afternoon. My name is Gorkin Alexander Evgenievich, I am an ophthalmic surgeon at the Scandinavia clinic. Today I would like to talk to you about such a disease of children in the first year of life as congenital blepharoptosis. Blepharoptosis, or drooping of the upper eyelid, appears in children from birth. It can be either unilateral or bilateral. The reasons for the development of blepharoptosis can be either neurological or underdevelopment of the muscle that lifts the upper eyelid. Blepharoptosis, as I already said, always appears from birth and can vary in severity. The degree of severity is determined by how much the upper eyelid covers the pupil - partially or completely. Treatment tactics will also depend on this in the future.

I would like to note that blepharoptosis is not only a cosmetic problem, but can also disrupt the normal functioning of the eye as an organ of vision. Firstly, the eyelid, covering the eye, does not allow it to work normally, which can lead to complications such as amblyopia or decreased vision. The eye does not work, as a result of which it may even deviate to the side over time, and strabismus develops. In addition, the upper eyelid puts pressure on the cornea. The cornea is the front transparent part of the eye and is one of the main lenses of the eye's optical system. Due to pressure on the cornea, its curvature develops. Astigmatism appears, which also leads to decreased vision and, subsequently, can lead to the development of amblyopia and strabismus. In addition, especially with bilateral ptosis, children very often raise their chin to compensate for the ptosis, looking as if from under their brows. This pose is called the stargazer pose, and with constant head tilting, children can develop disorders in the cervical spine. Thus, treatment tactics for blepharoptosis will, first of all, depend on the absence or presence of the listed complications. If there are no complications, and ptosis is exclusively a cosmetic problem, then surgical treatment is advisable to carry out at an older age of 3-5 years. If there is at least one of the listed complications, then it is advisable to perform the operation at the age of one year.

Our clinic provides surgical treatment of ptosis using various techniques. The choice of technique depends on how intact the function of the muscle that lifts the upper eyelid is in the child. If the muscle does not actually work and its function is very low, then a so-called suspension type operation will be performed. What does this mean? A thin silicone thread, about 1 mm thick, will be passed under the skin of the upper eyelid, which will be fixed to the frontal muscle. Thus, part of the functions of raising the upper eyelid will be carried out due to tension of the forehead muscles. If the child’s own muscles that lift the upper eyelid work well enough, then an operation will be performed to strengthen the action of this muscle, or, in other words, resection or shortening of the elevator of the upper eyelid. What
It will also lift the upper eyelid. Rehabilitation after such operations usually takes about 1 month. During this period, the child should be periodically observed by the ophthalmologist who operated at the clinic.

If a child has ptosis accompanied by strabismus, then, as a rule, it is necessary to operate on the strabismus first. Because, in this case, firstly, the position of the eyelid may change after surgical treatment of strabismus. Secondly, if the child has not corrected strabismus, and, accordingly, there is no binocular vision, then after correcting the ptosis he will not have the incentive to raise the upper eyelid and, accordingly, tense the forehead muscles.

Thus, early diagnosis of this disease is necessary, early diagnosis of all existing complications is mandatory, since the choice of tactics and timing of surgical treatment will depend on this. I would like to note that this problem is absolutely solvable, and it is possible to achieve a complete cosmetic and functional effect as a result of treatment.

Congenital prolapse can be caused by the following pathologies:

Genetic disease with an autosomal dominant pattern of inheritance. Ptosis in this case occurs due to underdevelopment of the muscle that lifts the eyelid. If one of the parents has congenital eyelid ptosis, the baby’s chance of getting this disease is 50%;

Pathology of the nucleus of the oculomotor nerve, which is responsible for the correct position of the eyelid and is located in the brain. This may be accompanied by both weakness of the superior rectus muscle and its normal tone;

Marcus-Gun syndrome or palpebromandibular syndrome, characterized, as a rule, by unilateral ptosis that disappears when opening the mouth or displacement of the lower jaw to the side opposite to the ptosis. It is caused by the formation of abnormal connections between the oculomotor and trigeminal nerves or their nuclei.

Blepharomyosis is a rare genetic syndrome with an autosomal dominant mode of inheritance, in which ptosis is caused by an abnormally short palpebral fissure and is often accompanied by epicanthus (a semilunar skin fold from the back of the nose to the inner corner of the eye) and telecanthus (an increase in the distance between the inner corners of the eyes due to elongation of the medial tendons ).

Acquired ptosis is much more common and can be caused by the following reasons:

Oculomotor nerve palsy due to diabetic neuropathy, tumors, or intracranial aneurysms compressing the nerve. In addition to ptosis, this pathology causes internal ophthalmoplegia (lack of pupil movement) and paralysis of the muscles around the eye. Drooping eyelids of this etiology are called neurogenic ptosis. This group also includes nerve damage after botulinum toxin injections - Botox therapy.

Myasthenia gravis is an autoimmune neuromuscular disease characterized by pathological fatigue of the striated muscles. In this case, bilateral eyelid drooping is observed, the severity of which depends on the load transferred to the corresponding muscles. Eyelid ptosis caused by myasthenia gravis is called myogenic.

In older people, aponeurotic ptosis is sometimes observed - the tension and fixation of the eyelid disappears due to the separation of the tendon of the muscle that lifts the eyelid from the plate to which it is attached.

Horizontal shortening of the eyelid due to a tumor or scar process is called mechanical ptosis.

Symptoms

The main symptom of ptosis is drooping of the eyelids of one or both eyes; it is accompanied by a number of associated symptoms, such as:

Rapid eye fatigue caused by a forced increase in effort when trying to open the eyes;

Eye irritation;

Strabismus, amblyopia (lazy eye syndrome) and diplopia (double vision);

“Stargazer pose,” which is especially common in children, is characterized by an upward-pointing face (a kind of method of compensating for a decrease in the field of vision);

Forms of the disease

In addition to dividing ptosis of the eyelid according to the reasons for its appearance, there are also three degrees of severity: with partial ptosis of the eyelid, its edge is located at the level of the upper third of the pupil, with incomplete ptosis - in the middle of the pupil, with complete ptosis - the pupil is completely covered by the eyelid. Classification according to the degree of damage is also used - eyelid ptosis can be unilateral or bilateral.

Diagnostics

A preliminary diagnosis of eyelid drooping should be taken into account as soon as the change is visible to the naked eye. Professional diagnosis of a disease such as ptosis of the upper eyelid in a child is carried out at an appointment with an ophthalmologist. The doctor will need information about hereditary diseases of the baby’s relatives, about the diseases that he suffered during a certain period of time before ptosis was noticeable. The doctor will then conduct a standard ophthalmological examination, as well as an examination of the affected eye itself, measuring the height of the eyelid, checking the symmetry and fullness of movement of the upper eyelids of both eyes. In rare cases, to clarify the cause of ptosis, a child may be prescribed a CT scan or MRI of the brain.

Treatment

The choice of treatment method for eyelid ptosis in a child will directly depend on the established cause of the ptosis and the age of the baby. For example, if incomplete ptosis is detected in an infant, observation is recommended with the possibility of subsequent surgical correction when the child grows up, since this type of ptosis does not impair vision, but only brings a cosmetic defect. Of course, in case of blocking of vision, which threatens the child with amblyopia, urgent surgical intervention is certainly indicated. Also, such a correction is resorted to in the case of observing the “stargazer pose” in a child, since throwing the head back contributes to various disorders in the cervical spine, slowing the development of motor skills and other troubles. Complete congenital ptosis of the eyelid in a child is an indication for surgical correction, regardless of age.

Any surgical treatment of blepharoptosis in children is carried out under general anesthesia, while local anesthesia is usually sufficient for adults. The standard operation consists of shortening the eyelid by forming a so-called levator duplicature (the muscle that lifts the eyelid), for this purpose three N-shaped sutures are placed on the patient's eyelid. In the case of congenital ptosis, this operation, as a rule, is not used, since too thin a layer of the muscles of the affected eyelid may not withstand the pressure - the sutures will cut through, and a relapse of the disease will occur.

An alternative operation for congenital ptosis of the upper eyelid is a technique for forming a duplication of the tarso-orbital fascia. The fold of the eyelid is strengthened, in addition to three N-shaped sutures, by using diathermocoagulation of the membrane of the muscles of the upper eyelid. This method in the treatment of ptosis of the upper eyelid can reduce the trauma of the operation and improve subsequent scarring of the eyelid muscles.

Another common surgical treatment for upper eyelid ptosis is resection of the levator palpebrae superioris muscle, which is used in cases where the shortened muscle prevents the eyelid from drooping. Muscle resection is performed through a thin skin incision.

Where to treat?

Choosing a clinic for diagnosis, and even more so for surgical treatment of eyelid ptosis in children is a very responsible matter. It is important to make sure that you have the necessary equipment, highly qualified ophthalmologists and, most importantly, their right to work with children - not all adult medical specialists are trained and ready to provide medical care to children.

Ptosis of the eyelid is a pathology of the location of the upper eyelid, in which it droops down and partially or completely covers the palpebral fissure. Another name for the anomaly is blepharoptosis.

Normally, the eyelid should overlap the iris of the eye by no more than 1.5 mm. If this value is exceeded, they speak of pathological drooping of the upper eyelid.

Ptosis is not only a cosmetic defect that significantly distorts a person’s appearance. It interferes with the normal functioning of the visual analyzer, as it interferes with refraction.

Classification and causes of eyelid ptosis

Depending on the moment of occurrence, ptosis is divided into:

Acquired
Congenital.

Depending on the degree of drooping of the eyelid, it happens:

Partial: covers no more than 1/3 of the pupil
Incomplete: covers up to 1/2 of the pupil
Full: The eyelid completely covers the pupil.

The acquired type of the disease, depending on the etiology (the cause of the appearance of ptosis of the upper eyelid), is divided into several types:

As for cases of congenital ptosis, it can occur due to two reasons:

Anomaly in the development of the muscle that lifts the upper eyelid. May be combined with strabismus or amblyopia (lazy eye syndrome).
Damage to the nerve centers of the oculomotor or facial nerve.

Symptoms of ptosis

The main clinical manifestation of the disease is drooping of the upper eyelid, which leads to partial or complete closure of the palpebral fissure. At the same time, people try to tense the frontalis muscle as much as possible so that the eyebrows rise and the eyelid stretches upward.

For this purpose, some patients throw back their heads and take a specific pose, which in the literature is called the stargazer pose.

A drooping eyelid prevents blinking movements, which leads to soreness and eye fatigue. Reduced blinking frequency causes damage to the tear film and the development of dry eye syndrome. Infection of the eye and development of an inflammatory disease can also occur.

Features of the disease in children

Ptosis is difficult to diagnose in infancy. This is largely due to the fact that most of the time the child sleeps and has his eyes closed. You need to carefully monitor the baby's facial expression. Sometimes the disease may manifest as frequent blinking of the affected eye during feeding.

At an older age, ptosis in children can be suspected by the following signs:

While reading or writing, the child tries to throw back his head. This is due to the limitation of visual fields when the upper eyelid droops.
Uncontrolled muscle contraction on the affected side. Sometimes this is mistaken for a nervous tic.
Complaints about rapid fatigue after visual work.

Cases of congenital ptosis may be accompanied by epicanthus(overhanging folds of skin over the eyelid), strabismus, damage to the cornea and paralysis of the extraocular muscles. If ptosis in a child is not corrected, it will lead to the development of amblyopia and decreased vision.

Diagnostics

A routine examination is sufficient to diagnose this disease. To determine its degree, it is necessary to calculate the MRD indicator - the distance between the center of the pupil and the edge of the upper eyelid. If the eyelid crosses the middle of the pupil, then the MRD is 0, if higher, then from +1 to +5, if lower, from -1 to -5.

A comprehensive examination includes the following studies:

Determination of visual acuity;
Determination of visual fields;
Ophthalmoscopy with examination of the fundus;
Examination of the cornea;
Study of tear fluid production;
Biomicroscopy of the eyes with assessment of the tear film.

It is very important that while determining the extent of the disease, the patient is relaxed and does not frown. Otherwise, the result will be unreliable.

Children are examined especially carefully, since ptosis is often combined with eye amblyopia. Be sure to check visual acuity using Orlova's tables.

Treatment of ptosis

Elimination of ptosis of the upper eyelid can only be done after determining the root cause

Treatment of ptosis of the upper eyelid is possible only after determining the root cause. If it is neurogenic or traumatic in nature, its treatment necessarily includes physical therapy: UHF, galvanization, electrophoresis, paraffin therapy.

Operation

As for cases of congenital ptosis of the upper eyelid, it is necessary to resort to surgical intervention. It is aimed at shortening the muscle that lifts the eyelid.

Main stages of the operation:

The operation is also indicated if the upper eyelid still remains drooping after treatment of the underlying disease.

After the intervention, an aseptic (sterile) bandage is applied to the eye and broad-spectrum antibacterial drugs are prescribed. This is necessary to prevent wound infection.

Medicine

Drooping upper eyelid can be treated with conservative methods. To restore the functionality of the extraocular muscles, the following therapy methods are used:

If the upper eyelid droops after a botulinum injection, then it is necessary to instill eye drops with alphagan, ipratropium, lopidine, and phenylephrine. Such drugs promote contraction of the extraocular muscles and, as a result, the eyelid rises.

You can speed up the lifting of the eyelid after Botox with the help of medical masks and creams for the skin around the eyelids. Professionals also recommend massaging your eyelids daily and visiting a steam sauna.

Exercises

A special gymnastic complex helps strengthen and tighten the extraocular muscles. This is especially true for involutional ptosis, which occurs as a result of natural aging.

Gymnastics for the eyes with ptosis of the upper eyelid:

Only with regular performance of a set of exercises for ptosis of the upper eyelid will you notice the effect.

Folk remedies

Treatment of ptosis of the upper eyelid, especially at the initial stage, is possible at home. Folk remedies are safe, and there are practically no side effects.

Folk recipes for combating ptosis of the upper eyelid:

With regular use, folk remedies not only strengthen muscle tissue, but also smooth out fine wrinkles.

Amazing results can be achieved with the combined use of masks and massage. Massage technique:

Treat your hands with an antibacterial agent;
Remove makeup from the skin around the eyes;
Treat your eyelids with massage oil;
Perform light stroking movements on the upper eyelid in the direction from the inner corner of the eye to the outer. When treating the lower eyelid, move in the opposite direction;
After warming up, lightly tap the skin around the eyes for 60 seconds;
Then continuously press on the skin of the upper eyelid. Do not touch your eyeballs when doing this;
Cover your eyes with cotton pads soaked in chamomile infusion.

Photo of ptosis of the upper eyelid

Reviews on surgery to remove ptosis of the upper eyelid

If you have had ptosis surgery, be sure to leave your feedback in the comments of this article, this will help a lot of readers

Ptosis of the eyelid (blepharoptosis) is the scientific name of a pathology that is characterized by its drooping, as a result of which the patient’s palpebral fissure is partially or completely blocked. At first glance, it may seem like a harmless, purely cosmetic problem, but in fact it can lead to serious vision problems. Most often, the disease is treated with surgery, but not all patients want to go under the surgeon’s knife. For what reasons does the upper eyelid droop, and is it possible to get rid of the pathology without surgery?

Ptosis of the upper eyelid - treatment without surgery

Causes of eyelid ptosis

Normally, the fold of the upper eyelid should cover the eyeball by no more than 1.5 mm - if these figures are too high or one eyelid lies significantly lower than the second, it is customary to talk about the presence of pathology. Ptosis has different etiologies and characteristics, depending on which it is divided into several types.

Blepharoptosis – drooping of the upper eyelid

The pathology can be congenital or acquired: in the first version, it manifests itself immediately after the birth of the child, and in the second, at any age. According to the degree of drooping of the eyelid, ptosis is divided into partial (1/3 of the pupil is blocked), incomplete (1/2 of the pupil) and complete, when the skin fold covers the entire pupil.

Mechanical ptosis of the upper eyelid is caused by the growth of a tumor on the upper eyelid, which, under the force of gravity, does not allow it to occupy the correct position

The congenital form of the pathology develops for several reasons - anomalies that affect the muscle responsible for the movement of the upper eyelid, or damage to nerves with similar functions. This occurs due to birth injuries, difficult childbirth, genetic mutations, and complications during pregnancy. There can be many more reasons for acquired ptosis - usually these are all kinds of diseases that affect the nervous or visual system, as well as directly the tissues of the eyes or eyelids.

Upper eyelid ptosis is often diagnosed in older people

Table. Main forms of the disease.

Neurogenic	The cause of the pathology is diseases of the central nervous system, including meningitis, multiple sclerosis, neuritis, tumors, stroke
Aponeurotic	It occurs due to stretching or loss of tone of the muscle that raises and holds the upper eyelid. Most often observed as a complication after plastic surgery for a facelift, or botulinum therapy
Mechanical	Develops after mechanical damage to the eyelids, ruptures and scars from healed wounds, as well as in the presence of large neoplasms on the skin, which, due to their severity, do not allow the eyelid to remain in its normal position
False	Observed with anatomical features of the eyelids (excessive skin folds) or ophthalmological pathologies - hypotonicity of the eyeball, strabismus

Blepharoplasty

For reference: Most often, ptosis is diagnosed in older people due to age-related changes in the body, but it can also occur in young people, as well as in childhood.

Symptoms of ptosis

The main sign of pathology is a drooping eyelid that covers part of the eye. Other symptoms may occur due to ophthalmic and other disorders, including:

discomfort in the eyes, especially after prolonged visual strain;
a characteristic pose (“stargazer pose”) that occurs involuntarily - when trying to look at an object, a person slightly throws back his head, tenses his facial muscles and wrinkles his forehead;
strabismus, diplopia (double vision);
difficulty trying to blink or close your eyes.

Main symptoms of pathology

Important: if ptosis occurs suddenly and is accompanied by fainting, severe pallor of the skin, paresis or muscle asymmetry, you should call an ambulance as soon as possible - in such cases, the pathology may be a manifestation of a stroke, poisoning accompanied by damage to the central nervous system, and other dangerous conditions.

Ptosis in children

In infancy, it is very difficult to notice pathology, since newborn children spend most of their time with their eyes closed. To identify the disease, you need to constantly monitor the baby's facial expression - if he constantly blinks when feeding or the edges of the eyelids are at different levels, parents need to consult an ophthalmologist.

Ptosis of the upper eyelid in a child

In older children, the pathological process can be detected by the following manifestations: when reading or other activities that require visual strain, the child constantly throws back his head, which is associated with a narrowing of the visual field. Sometimes uncontrollable muscle twitching is observed on the affected side, which resembles a nervous tic, and patients with a similar pathology often complain of eye fatigue, headaches and other similar manifestations.

Ptosis after Botox injection

Ptosis of the upper eyelid after Botox

Drooping of the upper eyelid is one of the most common complications women experience after Botox injections, and this defect can develop for several reasons.

Excessive decrease in muscle tone. The goal of botulinum therapy in the fight against wrinkles is to reduce muscle mobility, but sometimes the drug has an excessive effect, causing the upper eyelid and eyebrow to “creep” down.
Swelling of facial tissues. The muscle fibers paralyzed by Botox are not able to ensure normal lymphatic drainage and blood circulation, as a result of which too much fluid accumulates in the tissues, which pulls the upper eyelid down.
Individual reaction to Botox injections. The body's reaction to the drug can be different, and the more procedures were performed, the higher the risk of drooping eyelid and other complications.
Insufficient professionalism of a cosmetologist. When administering Botox, it is important to properly prepare the drug and inject it into certain points, which are chosen depending on the anatomical features of the patient’s face. If the manipulations were performed incorrectly, ptosis may develop.

Botox injection into eyelids

For reference: To reduce the risk of side effects after botulinum therapy, it is necessary to contact only experienced cosmetologists and carry out no more than 8-10 procedures over 3-4 years, and there should be intervals between them so that the muscles can restore mobility.

Another example of a cosmetologist’s mistake

Why is ptosis dangerous?

Pathology, as a rule, manifests itself gradually, and at first its signs may be invisible not only to others, but also to the patient himself. As the disease progresses, the eyelid droops more and more, the symptoms worsen, along with which vision deterioration, inflammatory processes in the eye tissues - keratitis, conjunctivitis, etc. can be observed. Eyelid drooping in childhood is especially dangerous, as it can provoke amblyopia (so called lazy eye), strabismus and other serious visual disturbances.

Amblyopia in children

Diagnostics

As a rule, to make a diagnosis of ptosis, an external examination is sufficient, but in order to prescribe the correct treatment, it is necessary to establish the cause of the pathology and identify associated complications, for which the patient must undergo a series of diagnostic measures.

Diagnosis of the disease

Determination of the degree of ptosis. To determine the degree of pathology, the MRD indicator is calculated - the distance between the skin of the eyelid and the middle of the pupil. If the edge of the eyelid reaches the center of the pupil, the indicator is 0, if it is slightly higher, then the MRD is assessed as +1 to +5, if lower - from -1 to -5.
Ophthalmological examination. Includes assessment of visual acuity, measurement of intraocular pressure, detection of visual field impairment, as well as external examination of eye tissue to identify hypotonicity of the superior rectus muscle and epicanthus, which indicates the presence of congenital ptosis.
CT and MRI. They are carried out to identify pathologies that could lead to the development of ptosis - disruption of the nervous system, neoplasms of the spinal cord and brain, etc.

MRI machine

Important: When diagnosing ptosis of the upper eyelid, it is very important to distinguish congenital pathology from the acquired form, since the treatment tactics of the disease largely depend on this.

Treatment of ptosis

It is possible to do without surgical treatment for drooping upper eyelid only in the first stages of the disease, and therapy is primarily aimed at combating the cause of the pathology. Drug treatment is carried out with injections of Botox, Lantox, Dysport (in the absence of contraindications), vitamin therapy and the use of drugs that improve the condition of tissues and muscles.

Botox for ptosis

The disadvantage of this approach is that almost all medications provide short-term effects, after which the pathology returns. If the drooping eyelid was caused by botulinum therapy, experts recommend waiting until the injected drug wears off - this can take from several weeks to 5-6 months. To improve the situation, local physiotherapy (paraffin therapy, UHF, galvanization, etc.), and in case of a mild defect, masks and creams with a lifting effect.

Galvanization

In cases where conservative therapy does not produce results, patients require surgical intervention to prevent complications. The operation depends on the form of the disease - congenital or acquired ptosis. In the case of a congenital form, surgical intervention consists of shortening the muscle that is responsible for the movements of the upper eyelid, and in the case of an acquired form, surgical intervention involves excision of the aponeurosis of this muscle. The sutures are removed 3-5 days after the procedure, and the recovery period lasts from 7 to 10 days. The prognosis for surgical treatment is favorable - surgery allows you to get rid of the defect for life and entails a minimal risk of complications.

Surgery

Attention: in childhood, surgical intervention can be resorted to only when the child turns three years old. To prevent the pathology from progressing, it is recommended to fix the eyelid with an adhesive plaster during the day, removing it at night.

Treatment with traditional recipes

Traditional methods of treating ptosis

Folk remedies for ptosis of the upper eyelid are used only in the first stages of the disease as a supplement to therapy prescribed by a doctor.

Herbal decoctions. Medicinal herbs effectively relieve swelling of the eyelids, tighten the skin and eliminate fine wrinkles. To combat drooping eyelids, chamomile, birch leaves, parsley and other plants with anti-edematous and anti-inflammatory effects are suitable. You need to make a decoction from the herbs, freeze it and wipe your eyelids with ice cubes every day.
Potato lotions. Wash raw potatoes, peel, chop well, cool slightly and apply to the affected area, after 15 minutes rinse the skin with warm water.
Firming mask. Take the yolk of a chicken egg, pour in 5 drops of vegetable oil (preferably olive or sesame), beat, lubricate the skin of the eyelid, hold for 20 minutes, then wash with warm water.

Raw potato wedges

With the second and third degrees of ptosis, especially if the pathology is congenital or caused by neurological diseases, folk remedies are practically ineffective.

Massage and gymnastics

You can improve the results from using traditional recipes with the help of massage, which is performed as follows. First of all, you need to wash your hands well and treat them with an antibacterial agent, and lubricate your eyelids with massage oil or regular olive oil. Perform light stroking movements on the upper eyelid in the direction from the inner corner of the eye to the outer, and then lightly tap it with your fingertips for a minute. Next, gently press on the skin so as not to injure the eyeball. Finally, rinse your eyelids with chamomile infusion or regular green tea.

Eyelid massage

Special gymnastic exercises for the eyes help not only improve the condition of the muscles and tissues of the eyelids, but also strengthen the eye muscles and get rid of eye fatigue. Gymnastics includes circular movements of the eyeballs in a circle, from side to side, up and down, closing the eyelids at different speeds. Exercises must be performed regularly, for 5 minutes every day.

Massage for ptosis

Eye gymnastics and eyelid massage can be performed as preventive measures to prevent the development of ptosis, but if there is no effect and the pathological process progresses, you should consult a doctor. Drooping of the upper eyelid is not just a cosmetic defect, but a serious pathology that can lead to ophthalmological disorders, therefore, if there are indications, one should not refuse surgery.

Video - Ptosis: drooping upper eyelid

Ptosis is drooping of the upper eyelid, which in this position covers part of the eye or covers it all.

It is believed that overlap of the iris by 2 millimeters is already a sign of ptosis.

But not all patients in such a situation agree to surgical intervention to eliminate such a defect.

Attention! If the drooping of the eyelid is severe, this disease is eliminated surgically.

Ptosis and its symptoms

You can read as much detail as possible about the causes and symptoms of ptosis in a separate article.

drooping eyelid may be acquired or congenital.

In the first case, injuries can provoke ptosis, although in old age the pathology can appear solely due to weakening of the muscle responsible for raising the upper eyelid.

Congenital ptosis is transmitted from parents to child and can be eliminated either through surgery or gymnastics, but one cannot particularly rely on non-surgical methods due to their low effectiveness.

In addition to drooping eyelids, less obvious symptoms of ptosis are:

Patients often experience chronic eye fatigue, and in these cases the disease cannot be tolerated, since the lack of treatment can lead to the development of visual defects.

Upper eyelid ptosis: treatment

Remember! Many people agree to surgery based on cosmetic or aesthetic considerations, but from a medical point of view, it is not the drooping eyelid itself that needs to be corrected.

Target surgical intervention - eliminate functional pathology of the eyelid muscle.

Is it possible to treat ptosis of the upper eyelid without surgery?

Conservative treatment without surgery, which consists of taking or local application of medications, has practically no effect for this pathology.

This can be said about gymnastics and even more so about folk remedies.

The only exception is the treatment of ptosis in young children using these methods. and only if the muscle that lifts the eyelid is only partially dysfunctional.

In rare cases, gymnastics can also help adults.

But the effect of such treatment is minimal, and it is more a way to prevent further drooping of the eyelid than a full-fledged treatment.

But you can try such gymnastics, because even if it does not have a visible effect, such exercises always help improve blood circulation in the tissues of the eyes and eyelids, and this can have a positive effect on rehabilitation after surgery.

You need to exercise daily according to the following scheme:

Before the main exercises, warm up.
When opening the eyes as much as possible, it is necessary to make circular movements with the eyes, then close your eyes slightly, but do not close your eyes completely.
You need to repeat this rotation cycle 3-4 times.
With the same maximum open eyes, you need try not to blink or squint for 10 seconds.
After which you can relax for a few seconds and repeat the procedure five more times.
Using your index fingers, lightly begin to massage your eyebrows, gradually making more rigid and intense movements, while also increasing the pressure.

Important! If there is no effect from the massage within a month, all that remains is to prepare for surgery: today this is the only effective method of eliminating ptosis.

Surgical method

Surgery to correct congenital ptosis differs from surgery performed for acquired disease.

In the first case, it is necessary to shorten the levator palpebral muscle, and in the second, to shorten its stretched aponeurosis (the wide tendon plate to which the muscle is attached).

Anyway The operation lasts about an hour under local or general anesthesia, depending on the severity of the disease.

If it is necessary to affect large areas, it is preferable to place the patient under general anesthesia.

For acquired ptosis, a small strip of skin is removed from the upper eyelid, and an incision is made through this area into the orbital septum.

Through it, the surgeon penetrates the aponeurosis of the muscle, shortens it and sutures it to the cartilage of the eyelid, which is located slightly lower. Next, the incision is stitched.

In the case of congenital neurosis, the doctor also gains access to the muscle through the incised orbital septum, but at the same time he places several sutures directly on it to shorten it.

Upon completion of the operation, a bandage is applied to the operated eyelid for several hours.

Need to know! At the same time, when the anesthesia wears off, most patients do not experience severe pain, so painkillers are practically not used during the rehabilitation process.

Later five days after the operation, the sutures are removed, although if healing goes well, this can be done a little earlier at the doctor’s discretion.

Traces of the operation in the form of swelling and bruising finally disappear after ten days..

What preventive measures are possible for ptosis?

For ptosis there are no preventive measures as such, especially when it comes to the congenital form.

But in the case of age-related ptosis, in which the muscles that lift the eyelids are stretched, you can try to slow down this process by using firming creams and serums.

And it is precisely in this case that regular gymnastics can help - with its help it is easy to keep muscles toned.

You can try using folk remedies and recipes:

Finely grated potatoes are placed in the refrigerator for 30 minutes, after which they are applied to the eyelids for 15 minutes.
After this time, the potato mass is washed off with warm water.
Beat raw egg yolk in a mixer or manually, then add 5-6 drops of sesame oil to it and mix thoroughly.
The finished mass is applied to the eyelid for 15 minutes and then also washed off with warm water.
Decoctions and infusions based on rosemary and lavender can be applied to the eyelids when severe inflammation occurs: such products soothe the skin well.
A decoction of chamomile, chilled in the refrigerator, is rubbed into the eyelids once a day..
To prepare a decoction, a teaspoon of herb is enough, which is poured with 200 grams of boiling water.

Useful video

From this video you will learn more about ptosis of the upper eyelid:

Ptosis is a defect that is practically impossible to treat at home..

With such a disease It is advisable to immediately contact plastic surgeons: the operation is not that expensive, and the cosmetic effect lasts a lifetime.

The upper eyelid defect is known as “blepharoptosis” or, in its abbreviated form, ptosis. The disease can develop under the influence of many causes and is a cosmetic defect that can be treated therapeutically.

Etiology of the pathological condition

Ptosis can affect one or both upper eyelids and is divided into:

for unilateral damage;
bilateral - with the fall of both eyelids.

The severity of changes directly depends on the severity of the process:

primary – characterized by partial drooping of the upper eyelid, with coverage of the eyeball no more than 33%;
secondary - in case of deviation, a significant omission is recorded, the visible area reaches 33 - 66%;
tertiary - total drooping of the upper eyelid completely covers the pupil area, visibility is zero.

The pathological process occurs in stages, with a gradual fall of the upper skin fold. During certain periods of time, deformation changes become more pronounced.

Experts distinguish several stages of the disease:

The first is that the visual changes are almost invisible. The facial muscles weaken, and bags, folds and dark circles begin to form around the eyes.
The second is characterized by the formation of a clear demarcation of the territory between the eye and cheek areas.
Third - noticeable manifestations are expressed in the drooping of the upper eyelids almost to the area of the pupils. From the outside, there is a feeling that the patient constantly has a sad, upset, dull and expressionless look. The effect is created of a glance from under the brows or of a frowning, dissatisfied person.
Fourth, the deepening nasolacrimal groove contributes to the drooping of not only the upper eyelids, but also the corners of the eyes. The changes that appear change the age of the patient - he looks much older.

Ptosis is registered when the distance between the borders of the upper eyelid and the iris is more than 1.5 mm.

Prerequisites and causes of ptosis

The development of the disease is caused by various external factors. The disease is considered from the point of view of a congenital and acquired defect.

Developed under the influence of various preconditions, the acquired form is further divided:

Aponeurotic - pathological deviation affects the structures that regulate the raising of the eyelids. Muscle fibers that have been stretched or damaged are characterized by impaired functionality. The formation of the disease occurs under the influence of inevitable changes; the risk group includes elderly patients.
Neurogenic - caused by disruption of the activity of nerve fibers responsible for the motor functionality of the eyes. The deviation is formed under the influence of reasons associated with a disorder of the nervous system:
- multiple sclerosis;
- stroke lesions;
- neoplasms in parts of the brain;
- abscess of the brain matter in the skull.
Mechanical - this type of pathology leads to shortening of the upper eyelid in the horizontal plane. Deviation occurs under the influence of factors:
- if there are neoplasms in the eyes;
- traumatization through foreign bodies in the eyes;
- ruptures in the integrity of mucous membranes and other areas;
- due to the ongoing scarring process.
Myogenic - registered after the formation of myasthenic syndrome - an autoimmune type of lesion of a chronic nature, leading to a decrease in overall muscle tone and increased fatigue.
False – the disease occurs under the influence of the following pathological conditions:
- severe strabismus;
- excess amount of eyelid skin.

The congenital variant of ptosis is formed under the influence of certain factors of intrauterine growth:

insufficient development or complete absence of the muscle responsible for the process of lifting the upper eyelid;
blepharophimosis - refers to rarely recorded genetic anomalies, characterized by shortening of the eye slits (in the vertical or horizontal plane) due to fused edges of the eyelids or chronic conjunctivitis;
palpebromandibular syndrome - disruption of the system responsible for raising the eyelids, caused by lesions of the brain stem with accompanying complications of strabismus or amblyopia.

An additional characteristic of Marcus-Gunn syndrome is the involuntary opening of the palpebral fissure during talking, chewing, or other jaw movements.

Symptomatic manifestations

Pathological deviation is accompanied by various symptoms. Commonly reported signs of ptosis include:

pronounced drooping of the borders of the upper eyelid;
slight inversion of the eyelids;
small volume of the affected eye;
shortened palpebral fissure;
a massive falling fold at the upper part of the eyelid;
eyes set close to each other;
rapid fatigue of the visual organs;
frequent hyperemia and irritation of the mucous membranes;
decreased visual acuity;
sensation of foreign objects in the area of the eyeballs;
sharp constriction of the pupil;
bifurcation of objects located in front;
infrequent or absent blinking;
constant movement of eyebrows;
involuntary tilting of the head back to raise the drooping eyelid;
inability to close the eyelids tightly;
in some cases - strabismus.

In exceptional cases, the lesion may be accompanied by symptomatic manifestations:

myasthenic syndrome, a feeling of constant fatigue and weakness in the afternoon;
myopathy, weakening of muscle structures that provoke partial closure of the eyelids;
involuntary raising of the eyelids when moving the jaw and opening the mouth;
palpebral dysfunction, expressed in the fall of the upper part and eversion of the lower part, a clear narrowing of the palpebral fissure;
simultaneous drooping of the eyelid, retraction of the eye and constriction of the pupil - a symptom of Claude Bernard-Horner.

Ptosis in children

Ptosis in children is divided into congenital and acquired. Ptosis is often combined with other disorders of eye functionality, among which the predominant ones are:

heterotropia - a pathology that makes it difficult to concentrate both eyes on one object, with a violation of their coordination;
Amblyopia is a deviation in which one of the organs of vision is not involved and the brain receives different pictures that it cannot connect into a single whole;
anisometropia - a disease characterized by a significant difference in eye refraction, which can be combined with astigmatism and occur without it;
Diplopia is a disorder that causes all objects in the field of vision to double in size.

Ptosis can be a manifestation of common diseases. The main prerequisites for the development of the disease in children include:

trauma received during the passage of the birth canal;
dystrophic type of myasthenia gravis - related to severe forms of autoimmune lesions affecting muscle fibers and nerves;
neurofibromas - a neoplasm that occurs on the nerve sheaths of the upper eyelid;
ophthalmoparesis – partial immobilization of the eye muscles;
hemangioma is a tumor-like formation that forms on blood vessels.

Congenital ptosis

It has classification features associated with the root causes of the development of a pathological condition in childhood:

Dystrophic form is one of the most frequently recorded, occurring:
- in case of deviation from the standard development of the structures of the upper eyelid;
- with weakness of the muscle elements of the upper muscle;
- with dystrophic changes in the levator;
- with blepharophimosis - genetically predisposed to insufficient development of the palpebral fissure.
Non-dystrophic form - characterized by stable performance of the muscles of the upper eyelids.
Congenital neurogenic - formed due to paresis of the third pair of cranial nerves.
Myogenic - transmitted along the hereditary line from mother to child.
Pathology combined with the Marcus Hun phenomenon is a condition characterized by spontaneous raising of the upper eyelids, formed when opening the mouth, swallowing movements, moving the lower jaw to the side (any functions performed by the masticatory department).

Favorable option

Ptosis of this type in children has its own prerequisites for formation and subtypes:

A deviation that arose as a result of a defective aponeurosis, characterized by the presence of excess skin folds and frequent swelling of the eyelids. Almost all recorded variants affect both eyes.

Neurogenic ptosis has its own varieties and causes:

damage to the motor pathway located in the region of the third pair of cranial nerves;
congenital Horner's syndrome - characterized by traumatization at the time the child passes the birth canal or other unknown origin;
acquired Horner's syndrome - as a sign of damage to the nervous system, formed after surgical interventions in the chest area or due to neuroblastoma (a malignant neoplasm that develops exclusively in childhood).

Myogenic ptosis – recorded in the presence of pathological abnormalities:

with existing myasthenia gravis – arising against the background of underdevelopment and neoplasms in the area of the thymus gland, characterized by lesions of the eye muscles, double vision of anteriorly located objects and asymmetry;
with progressive external ophthalmoplegia - partial paralysis of the cranial nerves responsible for the innervation of the eye muscles.

Mechanical - formed as a result of scar tissue and neoplasms on the skin of the upper eyelid.

False – fixed in case of disorders and disturbances in the movements of the eyeball up and down, in the presence of excess skin folds in the upper eyelid and in case of tumor-like formations on the vessels (hemangiomas).

Symptomatic manifestations and treatment regimen in childhood are practically no different from adults. Surgical procedures for the treatment of blepharoptosis in children are performed after they reach three years of age and subject to general anesthesia. Until the age of three, children develop their visual organs and the operation makes no logical sense.

Diagnostic tests

When contacting a medical institution regarding a developed deviation, the patient is sent for a number of research procedures:

to measure the length of the upper eyelid in the vertical plane;
determination of general muscle tone;
assessment of the symmetry of skin folds during blinking;
mandatory consultation with a neurologist;
conducting electromyography – for a comprehensive assessment of bioelectrical indicators of muscle potential;
radiographic image of the orbital area;
Ultrasound examination of the eye area;
MRI of brain regions;
identification of the existing degree of strabismus;
binocular vision test;
autorefractometry - determination of the optical characteristics of the organs of vision;
perimetric diagnostics;
determination of the level of ocular convergence - the level of convergence of the visual axes at the moment of viewing a nearby object.

After carrying out diagnostic measures, the attending physician makes a final diagnosis and enters the overall obtained clinical picture of the disease into the patient’s card. The specialist prescribes the necessary treatment regimen based on the data obtained and the general condition of the body.

Treatment of ptosis

The main method of correcting the pathological condition is surgical intervention. Surgical correction of the affected area is carried out under the influence of local painkillers; general anesthesia is used in childhood.

The total duration of the manipulation is about one and a half hours, the therapy consists of the standard scheme:

a small piece of skin is removed from the area of the upper eyelid;
an incision is made in the orbital septum;
the aponeurosis responsible for raising the upper eyelid is divided;
the damaged part of the aponeurosis is excised;
the remaining area is sutured to the lower cartilage of the eyelid;
suture material is applied on top;
The wound surface is treated and covered with a sterile bandage.

Surgical intervention is permitted after treatment of the pathology that is the root cause of the development of ptosis.

Commonly prescribed treatment options for ptosis include:

the use of electrophoresis;
local exposure to UHF therapy;
myostimulation;
galvanotherapy;
laser therapy;
fixing the damaged eyelid with a plaster.

Injection therapy

The latest development to suppress the symptoms of blepharoptosis is the use of injectable medications containing botulinum toxins:

"Dysport";
"Lantoxa";
"Botox".

Their range of effects is aimed at forced relaxation of the muscle fibers responsible for lowering the eyelid. The field of vision returns to normal after the procedure.

Before the manipulation, the specialist collects anamnestic data:

previous injuries;
chronic or inflammatory diseases;
all types of medications taken;
tendency to spontaneous allergic reactions;
hereditary factor - how many family members suffered from similar ailments.

In the complete absence of contraindications, after identifying the factors that influenced the onset of the disease and prescribing a complete treatment regimen, initial preparation for the procedure takes place. In the preoperative period, the patient signs consent to the proposed therapy option and is fully informed about the chosen technique.

The required level of concentration of the drug is determined by the doctor during a visual examination of the damaged area. Subcutaneous and intradermal types of injection are performed with insulin syringes. Before the manipulation, the surgical field is treated with antiseptics, and the locations of future punctures are outlined.

The total duration of the manipulation is five minutes, there is practically no pain. At the end of the procedure, the injection sites are treated a second time with disinfectants, and the sick person remains under the supervision of the attending physician for another half hour.

At the end of the manipulation measures, the rules of the postoperative period are again announced to the patient:

during the first four hours, be exclusively in a vertical position;
It is prohibited to bend over and lift heavy things;
It is not recommended to touch or knead the injection sites;
The consumption of alcoholic and low-alcohol drinks is prohibited;
Do not apply high temperatures to puncture sites - all warming and pressing bandages and compresses are prohibited;
It is strictly forbidden to visit saunas, baths and steam rooms - in order to avoid destroying the positive effect.

The restrictions apply for a week. The desired result is registered two weeks from the moment of the manipulation and lasts for six months, with gradual weakening. The therapeutic effect of Botox is a real substitute for surgery for partial or incomplete ptosis of the upper eyelid.

Home therapy

Independent elimination of the pathological condition is auxiliary in the primary stages of development of the deviation. To suppress a cosmetic defect, it is recommended to use:

specialized compresses;
masks;
gymnastic exercises - to strengthen the muscles of the facial region.

If the desired result is not achieved, the patient requires consultation with a doctor and further treatment in a hospital setting.

Gymnastics for ptosis - helps strengthen weakened muscles and includes periodic performance of certain exercises:

With eyes wide open, circular movements are performed - a thorough inspection of surrounding objects is carried out. Without closing your eyes, attempts are made to close your eyes. The technique is repeated several times in a row.
Maximum opening of the eyes and holding them in this position for 10 seconds. This is followed by a tight closure, with muscle tension, for 10 seconds. A total of six repetitions are performed.
The index fingers are placed in the eyebrow area. After light pressure, they are brought together without forming a wrinkled fold. This step should be performed until pain appears in the muscles.
The eyebrow area is massaged with the index finger, by stroking and gentle pressure.

Muscle gymnastics allows you to tighten weakened facial muscles. Manipulations are prohibited in case of infectious and inflammatory processes affecting areas of the upper eyelid.

Medicinal creams – belong to the most simplified means for the treatment of ptosis. Pharmaceutical and cosmetic companies produce a sufficient number of creams with a tightening effect.

The effectiveness of the effect depends on the degree of damage - in the initial phases, the products produce a positive effect - subject to daily use. Upon completion of cosmetic procedures, all effectiveness will quickly subside and the condition will return to its original state.

Preventive actions

To prevent secondary or primary formation of ptosis, experts recommend that patients change their usual lifestyle:

review the principles of the daily diet - use food products enriched with essential vitamins and minerals;
exclude alcoholic and low-alcohol drinks;
provide treatment for chronic nicotine and drug addiction;
exercise regularly - daily walks in forested areas, training, gymnastics, swimming;
stabilization of the rest and work schedule - nightly sleep should be at least eight hours, you need to go to bed and get up at the same time.

As preventive measures in old age, it is recommended:

undergo regular preventive examinations with an ophthalmologist;
promptly treat eye diseases;
Periodically visit a neurologist for consultation.

Treatment of changes caused by the aging of the body is impossible at home. To suppress negative symptoms, you should go to your local clinic, take all the necessary tests and receive a symptomatic treatment regimen.

Ptosis is a disease that requires timely seeking medical help. In case of an advanced form of pathological deviation (above the second stage), the only treatment option will be mandatory surgical intervention. Ignoring the primary signs of the disease will allow the disease to quickly progress.

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