Ptosis causes. Ptosis - what is it? Causes of the disease, treatment

PTOSIS of the upper eyelid is a fairly common symptom, characterized by drooping of one or two upper eyelids due to decreased muscle tone or impaired nerve patency.

PTOZ of the eyelid as an independent disease does not pose a significant health hazard, but is a significant aesthetic drawback and often creates significant problems with vision. With severe disruption of innervation, patients often have to raise their chin and eyebrows high to open the pupil and see objects.

Now let's talk in more detail about what PTOZ of the upper eyelid is, what its causes are and whether correction is possible.

Causes and etiology

There are both congenital and acquired types of the disease. Specialists definitely recognize bilateral PTOZ as congenital, when there is drooping of the upper eyelid in both the left and right eyes.

Congenital and acquired types of the disease are possible. No more than 25% of people suffering from the disease are characterized by congenital drooping of the upper eyelid. The causes are predominantly genetic. Less commonly, PTOS is a consequence of birth trauma. Quite often, the congenital type of the disease is associated with other visual anomalies: strabismus and “lazy eye” syndrome - amblyopia.

If PTOS does not accompany other eye diseases and is caused only by underdevelopment of the upper eyelid muscle, then it is dominant in inheritance. As a rule, if one of the parents has PTOSIS, the defect is passed on to the child as a dominant trait.

Less common are cases in which drooping of the upper eyelid is caused by pathologies of the optic nerve. A patient with this picture of the disease is characterized by the so-called “stargazer pose” - a constantly raised chin or raised eyebrows.

Sometimes congenital PTOS of the upper eyelid is associated with a rare genetic disorder known as palpebromandibular syndrome. With it, the muscles of the upper eyelid are innervated by the action of the jaw muscles, in other words, the eyelid opens completely when a person chews. Most often, the disease is associated with strabismus and underdevelopment of one of the eyes.

Another rare genetic disorder that causes drooping eyelids is blepharophimosis.

This disease is characterized by underdevelopment of the palpebral fissure - it is abnormally short and does not allow either lowering or raising the eyelids. In this case, the presence of double blepharoptosis is noted - both eyelids are closed by more than 2.3 mm, which creates significant difficulties for vision. With blepharophimosis, inversion of the lower eyelids may occur.

The manifestations of congenital PTOSIS can, as a rule, be stopped or minimized only by surgery.

Acquired PTOZ of the upper eyelid is much more common. The causes of the disease can be due to both serious neurogenic disorders and simple mechanical obstacles when opening the eyelids.

Neurogenic PTOS is characterized by the presence of diabetic brain pathologies and tumors that compress the oculomotor nerve. The eyelids may close completely. For PTOSIS of the upper eyelid caused by pinching of the oculomotor nerve, treatment is aimed at eliminating the root cause of the disease. In some cases (for example, when treating corneal lesions), specialists artificially cause complete drooping or significant drooping of the upper eyelid by surgically compressing the oculomotor nerve.

If significant damage to the tendons has occurred in the tissues of the upper eyelid, the muscles of the upper eyelid lose tone - this picture of the disease is characteristic of aponeurotic PTOSIS. As a rule, drooping eyelids due to tendon damage occur as a result of injuries and after the entry of foreign objects.

Almost always acquired PTOS accompanies myasthenia gravis, a disease in which the fibers of the body muscles, including the oculomotor muscles, lose tone due to the presence of antibodies in the muscle tissue of the eyelid. With myogenic PTOSIS, the eyelids of both the left and right eyes droop. When diagnosing the disease, endorphin is used; after its administration, symptoms (including bilateral PTOS) disappear for a while.

Often, atony of the eyelid muscles is a consequence of diseases of the nervous system, including stroke and meningitis.

Neurogenic PTOS also causes Horner's syndrome, a specific lesion of the sympathetic nervous system with cervical nerve palsy. When treating PTOSIS of a neurogenic nature, efforts are aimed at general recovery - experts do not recommend performing cosmetic surgery while fighting the consequences of the underlying disease.

Mechanical drooping of the eyelids is characteristic of tumors, foreign body penetration and tissue scarring due to injury.

Diagnosis of PTOS

When the upper eyelid droops, a specialist must clearly understand the etiology of the disease; diagnosis comes down to finding the causes. If there is drooping of the upper eyelid, the reasons may be different. In case of congenital PTOSIS, treatment tactics come down to minimizing and relieving symptoms; in case of acquired PTOSIS, it is to eliminate the primary causes.

First of all, the specialist conducts a differential diagnosis, it is necessary to exclude infectious diseases and paresis.

Next is a detailed survey and anamnesis collection. The specialist receives information about cases of the disease in the family, as well as the presence (or absence) of third-party pathologies that can cause or provoke drooping eyelids. If PTOS of the upper eyelid is noted, only a doctor can determine the cause.

During diagnosis, an ophthalmological examination is required to identify possible disorders, check visual acuity and the degree of intraocular pressure.

In cases of acquired disease, a specialist often refers the patient to CT and MRI; sometimes PTOZ serves as the primary symptom of tumor diseases of the brain.

Treatment methods

Treatment of PTOS of the upper eyelid is carried out both conservatively and surgically. Only a doctor can tell you what to do in a particular case. Many people try to carry out treatment at home without diagnosis and supervision from a specialist.

Conservative method - treatment without surgery. This method is used to restore lost muscle tone and nerve conduction. How to treat such a disease? The range of activities includes:

  1. Physiotherapy.
  2. Muscle and nerve stimulation (using galvanic current)
  3. Application of a special patch for mechanical lifting of the eyelid. Significantly aggravates cosmetic imperfections, but is necessary to avoid further complications, especially for children.
  4. Laser therapy.

According to experts, conservative treatment measures are rarely successful, but are quite effective in treating PTOSIS of neurogenic etiology, when the disease is caused by pinching of the oculomotor nerve. For blepharophimosis and scars on the tissue of the upper eyelid, only surgical intervention is indicated; in other cases, eyelid surgery is prescribed after 6 months of conservative treatment, which has proven ineffective.

Correction of PTOSIS of the upper eyelid almost always involves surgical intervention.

A particularly operative method of treatment is indicated for children; a long-term lack of adequate treatment as they grow older can turn a cosmetic defect into a progressive disease.

There are several surgical treatment tactics. If the upper eyelid has drooped and almost lost its mobility, the surgeon tries to cure and lift it by suturing it from above (to the forehead muscle). This method of treatment is not very effective, but is practically free of complications. This surgery is sometimes performed on children (when the eyelid droops) as an intermediate step to reduce the risk of vision loss.

In the case where the drooping eyelids are mobile, the surgeon resorts to resection of the muscle. Through a small incision, the doctor removes a small area of ​​skin and cuts the muscle that lifts it. Reducing the volume of muscle tissue does not allow the eyelid to droop spontaneously.

In most cases, postoperative recovery is fairly quick and without complications - the sutures are removed already 3–5 days after surgery.

The prognosis is generally favorable, repeated interventions after blepharoplasty are almost never performed, and the effect lasts for life.

Home and traditional methods

Many people decide to treat PTOZ at home without supervision from an ophthalmologist. The disease has been known for a long time, so treatment with folk remedies is very common.

In order to increase the therapeutic effect during treatment at home, several methods are usually used at once.

A common and inexpensive remedy is a lifting mask based on natural ingredients:

  1. Egg yolk is mixed with sesame and olive oils and applied to the skin of the eyelid for 20 minutes.
  2. Finely grated and cooled potatoes are applied for 15–20 minutes. According to practitioners, the colder it is, the more effective it is.
  3. Grated thyme and chamomile are applied to the eye for 15–20 minutes. Indeed, the natural antiseptic in chamomile can eliminate inflammation that often occurs during the use of other folk remedies.

The use of masks is possible and gives a certain therapeutic effect, but in the case of PTOSIS of neurogenic or genetic etiology, such methods will be powerless, since they do not eliminate the root cause of the disease.

Therapeutic gymnastics and massage

More effective method. It can have a positive effect even with a congenital type of disease, if it is associated with low muscle tone. To achieve the effect, you need to do gymnastics regularly for quite a long time.

  1. They start with a warm-up: you need to open your eyes as wide as possible, look around you in a circular motion and squint. Repeat 5-6 times.
  2. Keep your eyes open as much as possible for 10 seconds. Close your eyes tightly for 10 seconds. Repeat 5-6 times
  3. As a second exercise, bring the eyebrows to the bridge of the nose with your index fingers and repeat until the muscles hurt.
  4. Final exercise - stroke the eyebrow with the index finger, gradually accelerating and pressing harder

The effectiveness of eye gymnastics is due to an increase in the general tone of the oculomotor muscles, and as a result, the muscles of the drooping eyelid.

In combination with regular diagnostics, massage has a moderate therapeutic effect, increasing the tone of the eyelid muscles and improving their blood supply.

The procedure is carried out in 4 stages:

  1. Preparatory. You need to thoroughly wash your hands and the skin around your eyes. Before starting the massage, make sure there is no irritation or redness. Apply moisturizer to clean skin before starting.
  2. Elementary. The skin around the eyes is stroked with the index fingers; they pass along the eyebrow without touching the eyelid. After you make a few circles, you need to blink a little
  3. The main one is to rub the eyebrows one by one with the index finger in one direction from the bridge of the nose. Repeat 10-15 times for each eyebrow.
  4. Repeat the initial stage as the final one.

In home therapy, ice cubes made from water or chamomile decoction are used to relieve swelling. Applying ice before or immediately after a massage is not recommended, as this reduces the effectiveness of the procedures.

Conclusion

Even if self-treatment had a therapeutic effect, professional diagnosis, consultation and monitoring by an ophthalmologist are necessary to avoid complications.

Plan your surgery carefully, especially if the surgery involves muscle resection. Incorrect truncation can lead to the fact that the eyelid stops closing altogether - before the operation, carefully familiarize yourself with the reputation of both the clinic and the specific specialist. Do not save on time and money - a correctly performed operation will forever eliminate the need for repeated surgical interventions.

Upper eyelid ptosis– age-related changes in muscles and tissues caused by gravity, but the pathology can occur against the background of diseases of the nervous and endocrine systems, often develops with injuries and tumor processes in the body, and can be congenital and hereditary in nature.

Drooping of the upper eyelid is most often an age-related change

Symptoms of drooping upper eyelid

Blepharoptosis (ptosis)– an ophthalmological disease, characterized by drooping of the upper eyelid below the border of the iris by 2 mm or more; the disease begins to develop with muscle abnormalities.

How the disease manifests itself:

  • eyebrow arches lose their bend;
  • the head is slightly thrown back;
  • eye irritation, frequent conjunctivitis;
  • eyes get tired quickly even with minimal loads;
  • blurred image;
  • dry eye syndrome.

Against the backdrop of an impending eyelid, a functional decrease in visual acuity almost always occurs.

Classification of ptosis

Blepharoptosis can be congenital or acquired, depending on the origin and severity of the pathology; ptosis is divided into several types. ICD code 10 is H 02.4, congenital ptosis is Q 10.0.

Types of pathology:

  • aponeurotic– occurs when the muscle that lifts the upper eyelid is stretched and weakened, develops after plastic contouring;
  • neurogenic - a consequence of diseases of the nervous system, accompanied by constriction or dilation of the pupil, one eyelid is noticeably lower than the other;
  • myogenic – develops with myasthenia gravis, the disease is transmitted to the child from the mother;
  • mechanical - the result of scars on the eyelid, a foreign object entering the eye;
  • false ptosis – the impression of a looming eyelid is created by skin folds;
  • oncogenic – a consequence of tumor processes.

Children are more often diagnosed with congenital dystrophic and non-dystrophic ptosis, a neurogenic form of the disease.

Degrees of ptosis

As the disease progresses, the eyelids droop more and more, closing the eye; with senile ptosis, the pathology is accompanied by a number of additional symptoms.

1st degree of ptosis - partial, the pupil is 1/3 closed

  1. With stage I age-related ptosis, folds form on the upper eyelid, circles and bags under the eyes, eyebrows rise, and the nasolabial triangle stands out.
  2. At stage II, deep folds occur between the eyebrows, many small wrinkles form around the eyes, and the eyelids descend to the eyelashes.
  3. At stage III, all signs intensify, the eyelids droop, close the eyes, and the condition and appearance of the skin worsens.

Before and after hemiptosis surgery

Before and after surgery for partial ptosis

Causes of ptosis

Congenital ptosis develops due to underdeveloped muscles of the upper eyelid, or its complete absence, and is often accompanied by amblyopia and strabismus.

Causes: hereditary pathologies, intrauterine abnormalities.

Reasons for the development of acquired ptosis:

  • pathologies of the nervous system, which are accompanied by paresis, paralysis;
  • injuries to the organs of vision, ophthalmological operations;
  • endocrine pathologies;
  • long-term use of hormonal drugs;
  • stretching in the area of ​​​​the connection of the upper eyelid muscle with the tendon;
  • age-related tissue drooping due to gravity;
  • the presence of neoplasms in the brain, orbit.

Drooping of the eyelid occurs due to age-related reasons, as well as a number of serious diseases.

Congenital ptosis is most often bilateral; the acquired form of the pathology is diagnosed in one eye.

Ptosis in children

Drooping eyelids in a child occur due to birth injuries, nerve tumors, hemangioma, and partial paralysis.

Causes of congenital ptosis:

  • the appearance of a third fold;
  • genetic underdevelopment of the palpebral fissure;
  • dystrophic myasthenia gravis – a severe autoimmune disease;
  • palsy of the third pair of cranial nerves;
  • Marcus-Hun phenomenon - the eyelids involuntarily rise with the movement of the masticatory muscles;
  • neuroblastoma.

The child’s eyelid is almost closed - complete ptosis

An acquired form of pathology in children develops when the functions of the thymus gland are impaired, after eye injuries.

It is difficult to recognize ptosis in newborns; one of the main signs is frequent blinking during feeding.

Which doctor should I contact?

Diagnosis and treatment of ptosis and, if necessary, surgery, consultation.

Diagnostics

To diagnose ptosis, a simple examination is enough to determine the degree of pathology; the doctor measures the length between the edge of the upper eyelid and the center of the pupil.

Stages of a comprehensive examination:

  • corneal examination;
  • analysis of the functions of the lacrimal gland;
  • adrenaline test;
  • assessment of visual acuity;
  • measurement of intraocular pressure;
  • biomicroscopy of the eye;
  • X-ray, CT scan of the eye;
  • MRI of the brain.

The topography of the brain will make it clear in which area the problem is, but such diagnostics are not always carried out

When determining the degree of ptosis, you should not frown or tense - this will distort the measurement results.

Methods for eliminating ptosis

After identifying the root cause of drooping eyelid, the correct treatment is selected. Complex therapy consists of traditional and non-traditional methods.

Treatment without surgery

Effective methods for grades I and II, if the procedures are carried out regularly and correctly, it will take 3–6 months to eliminate the drooping upper eyelid.

Gymnastics

A special set of exercises strengthens and tightens the eye muscles; gymnastics helps well with senile ptosis.

Exercises:

  1. Fix your gaze on the object, make slow circular movements with your eyes clockwise. Repeat 7 times.
  2. Look up, open your mouth, blink frequently. Perform the exercise for 30 seconds, gradually increase the time to 3-4 minutes.
  3. Close your eyes, open them wide on the count of 5, and look forward. Repeat 7-8 times.
  4. Open your eyes, press your fingers lightly to your temples, slightly stretch the skin, blink frequently for 30 seconds.
  5. Eyes closed, slightly stretch the skin near the outer corners of the eye. Overcoming resistance, raise your eyelids as high as possible. Perform 5 repetitions.
  6. Tilt your head back, close your eyes, fix the position on the count of 10.

Eye exercises for ptosis

You need to perform gymnastics in the morning and evening; with regular exercise, the effect is noticeable after 2–4 weeks.

Massage for blepharoptosis

Massage in combination with gymnastics and folk remedies allows you to achieve noticeable improvements in the impending eyelid.

Procedure steps:

  1. Cleanse skin of cosmetics.
  2. Treat your hands with antiseptic preparations.
  3. Apply hypoallergenic massage oil to the skin of the eyelids.
  4. To warm up the skin, use light stroking movements to move along the upper eyelid from the inner corner to the outer edge.
  5. Make movements on the lower eyelid in the opposite direction.
  6. Use skin pads to tap the skin around the eyes for 1 minute.
  7. Press on the skin of the upper eyelid for a count of 5, repeat after a short break. Perform the exercise 5–7 times.

Eyelid massage for ptosis will give a noticeable and visible effect

After the end of the session, apply a compress of chamomile or green tea infusion to your eyes and lie down for 5 minutes.

How to remove ptosis with folk remedies

Alternative medicine is used to prevent and treat the initial stage of ptosis.

Simple recipes:

  1. Mix in equal parts chamomile inflorescences, cornflower, green tea leaves, 1 tbsp. l. collection, pour 250 ml of boiling water, leave in a closed container for 30 minutes, strain. Pour the infusion into ice cube trays, freeze, and wipe the skin around the eyes every morning.
  2. Mix 30 g of chopped fresh parsley and birch leaves, 1 tsp. collection, pour 220 ml of water, simmer over low heat for 5 minutes, strain. Soak cotton pads in the broth and apply to eyes for 15 minutes 3-4 times a day.
  3. Beat the egg yolk, add 3-4 drops of sesame or olive oil, apply the mixture to the upper eyelid. Wash off after 20 minutes, perform sessions daily for 2-3 weeks.
  4. Grate raw potatoes, put in the refrigerator for 20 minutes, and make a compress on the eyes. After a quarter of an hour, remove the mass with warm water.

Folk remedies help tighten drooping eyelids and cope with wrinkles, circles and bags under the eyes.

Medicines

Drug treatment for ptosis is ineffective; at the initial stage of the disease, drugs based on apraclonidine are prescribed - Cytoflavin, Clonidine, B vitamins, these drugs cause contraction of the eye muscles.

B vitamins contract muscles

Administration of Botox preparations– after the injection, muscle paralysis occurs, the upper eyelid rises. The duration of the procedure is no more than 20 minutes, discomfort rarely occurs, after the injection the skin is treated with antiseptics, the recovery period takes 7–8 days.

The effect of the operation is noticeable after 2 weeks and lasts for 6–12 months. The method is suitable for eliminating manifestations of partial and incomplete ptosis.

Ptosis – often occurs after Botox when the drug is administered incorrectly to eliminate wrinkles, but within 4 weeks the problem disappears on its own.

Other correction methods

Conservative treatment methods help restore the functions of the damaged nerve; they are used in the neurogenic form of the pathology.

Treatment methods:

  • UHF therapy is a gentle effect on the cornea with a high-frequency electromagnetic field, after the procedure muscle spasms disappear, blood circulation and the passage of nerve impulses improve;
  • galvanotherapy– damaged areas are exposed to low voltage direct current, damaged nerves and muscles are restored, metabolic processes are normalized;
  • paraffin therapy– under the influence of heat, metabolic processes in tissues are accelerated, muscles are gradually strengthened;
  • ultraphonophresis with medications, the action of which is aimed at improving the functioning of the eye muscles, enhancing the synthesis of collagen and elastin;
  • laser therapy– one of the best methods of treatment, after 2 weeks metabolic processes are normalized, muscle function improves, swelling disappears;
  • myostimulation - the effect of electrical impulses on muscles and nerve endings, which leads to strengthening of the fibers.

Exposure of the eye to an electromagnetic field

Duration of conservative therapy– 6 months, if no noticeable improvements are observed, the person is recommended to undergo surgery.

Physiotherapy procedures are contraindicated for diseases of the heart, blood vessels, severe forms of hypertension, mental disorders, epilepsy, and during exacerbation of infectious pathologies.

Operation

Several surgical methods are used to correct a drooping eyelid, each of them has its own advantages and disadvantages.

Classic operation

Surgical intervention is performed for severe forms of congenital ptosis; during the operation, the muscle that raises the eyelid is shortened. Average cost – 15–25 thousand rubles.

Photos before and after blepharoplasty

Operation stages:

  1. The surgeon makes an incision in the upper eyelid area.
  2. The muscle or tendon of the eyelid is exposed through the incision.
  3. A small piece of muscle is excised.
  4. The application of cosmetic sutures, after resorption they are not visible, no scars remain.

After surgery, a sterile bandage is applied to the eye, and antibacterial drugs are prescribed to avoid infection.

If a child has ptosis, surgery is performed only after 3 years of age - before this age, the organ of vision is actively developing. But if the baby has a tilted head, the functions of the lacrimal glands are disrupted, then the defect is removed immediately surgically.

A modern method of treating ptosis belongs to the methods of plastic surgery and is suitable for eliminating the age-related form of the pathology. Average cost – 28–38 thousand rubles.

Before and after blepharoplasty

  1. Procedure steps:
  2. A marker marks the location of the incision.
  3. Local anesthesia is administered.
  4. Laser cuts are made according to the markings - under the influence of high temperatures, fat, old, damaged cells are destroyed.
  5. Stitching.
  6. Apply antiseptic ointment and secure the incision site with a bandage.

Blepharoplasty does not require hospitalization; after completing all necessary procedures, you can go home.

Possible complications

If ptosis is not treated, amblyopia develops and vision rapidly deteriorates. With complete unilateral ptosis, they give disability group III; with a bilateral form of the disease - II.

Possible complications after surgery are conjunctivitis, photophobia, sometimes eversion of the eyelid, and slight asymmetry.

What to do to prevent ptosis

To avoid the appearance or recurrence of blepharoptosis, it is enough to follow simple rules of prevention.

How to prevent the development of ptosis:

  • promptly treat all diseases that can cause drooping eyelids;
  • When performing hazardous work, use safety glasses;
  • do not try to remove a foreign body in the eye yourself;
  • after 30 years, start doing gymnastics, massage to strengthen the eye muscles, use high-quality cosmetics with a lifting effect;
  • Be careful when choosing a clinic or plastic surgeon if you need to administer Botox.

A sedentary lifestyle can lead to any disease - get moving

Smoking, alcoholic drinks, junk food, and a sedentary lifestyle negatively affect the condition of the body as a whole, and the eye muscles in particular.

Many people consider ptosis to be a non-serious disease: it is not life-threatening, does not cause serious complications and is, rather, a cosmetic defect. However, drooping eyelids 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 - go down. If in the case of kidneys or breasts this happens almost imperceptibly, then drooping eyelids are visible to the naked eye. This disease is called ptosis, which means “fall” in Greek.

The problem can occur in both adults and children, including infants. This defect is most often passed on to children from their parents, being hereditary. In adult men and women, ptosis occurs for various reasons: due to muscle paralysis, tumors, scars.

In older people, ptosis most often develops due to decreased skin elasticity and age-related changes. In youth, the border between the eyelid and cheek is invisible, but over time, the subcutaneous fat covering the bone of the orbit moves down, forming characteristic “bags” - ptosis of the lower eyelid appears. The tissues above the eyes also undergo changes. Excess skin forms on the upper eyelid, which moves downward, covering the iris. Age-related ptosis can be divided into 4 stages.

  1. Ptosis only on the lower eyelids.
  2. Drooping of both lower and upper eyelids.
  3. Along with the eyelids, the tissues of the cheeks and cheekbones droop, and deep nasolabial folds form.
  4. Drooping of the corners of the eyes, exposure of the sclera, formation of a deep nasolacrimal groove.

Ptosis causes significant discomfort for both older and younger people. Young people have a lot of complexes about their appearance, and old people, who often suffer from poor eyesight, have to strain a lot to see anything with a half-closed eye. Patients are often forced to tilt their heads back to increase the viewing angle, taking a characteristic “stargazer pose.”

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

Acquired ptosis has the following types:

  • neurogenic - occurs due to neurological problems;
  • mechanical - provoked by 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 functioning of striated muscles;
  • aponeurotic - appears due to the separation of the tendon that lifts the eyelid from its attachment site due to injury 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 in both organs of vision at once. As a rule, unilateral ptosis is often acquired, while bilateral ptosis 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 reasons.

Congenital ptosis occurs due to:

  • genetic predisposition;
  • underdeveloped muscle that lifts the upper eyelid;
  • pathologies of the oculomotor nerve;
  • Hun's syndrome, which is manifested by drooping of the eyelid when the masticatory muscles work;
  • 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;
  • rapid fatigue of the muscles that lift the eyelids;
  • eye injuries;
  • advanced age;
  • scars in the eye area.

The last reason is a consequence of operations or cosmetic procedures. Thus, ptosis often occurs after Botox injections and other interventions for facial rejuvenation.

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

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

Ptosis also comes in varying degrees of severity. If untreated, the disease progresses quite quickly from partial to complete drooping of the eyelid.

Degrees of ptosis - table

When the first signs of drooping eyelid appear, do not hesitate to visit a doctor. Timely treatment can return the patient to his previous appearance without the use of surgical correction methods.

Diagnostics

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

Before the examination, a conversation is held with the patient, on the basis of which the doctor makes a conclusion about whether the pathology is congenital. The course of treatment can also be affected by the presence of other diseases in a person, so the specialist’s responsibilities also include drawing up 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 must have myasthenia gravis - chronic muscle weakness, which the patient simply cannot be unaware of.

After collecting anamnesis, the doctor examines the patient, which includes:

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

If the doctor determines that ptosis is caused by oculomotor nerve palsy, he may order an ultrasound of the eyes, X-rays of the orbit, and magnetic resonance imaging 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 corrected 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 is not always possible to achieve a positive result with its help. Therefore, doctors prescribe such procedures only if they have firm confidence in their effectiveness for a particular patient.

  1. Use of tightening agents. 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 only help in cases of partial ptosis. If the eyelid covers more than half of the pupil, they will not give a pronounced effect. The tightening cream should be used daily, without skipping, and the drug should be tested before starting treatment, since people prone to allergies may experience undesirable reactions to such products.
  2. Massage. Regular therapeutic massage helps strengthen the muscles of the eyelids, but it is most often useless in cases of severe ptosis.
  3. Fixing the eyelid with adhesive tape. 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, since it causes additional discomfort to patients, both physical and psychological.
  4. UHF therapy. Treatment with a high-frequency electromagnetic field is very effective for neurogenic ptosis, when it is necessary to restore nerve function.
  5. Galvanization. Local application of low-intensity 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.
  6. Paraffin therapy. Paraffin masks are used to tighten facial muscles and are effective at the stage when ptosis is not yet pronounced, but the pathological process has already begun. They are used 1–2 times a week until the desired effect is obtained and 2–3 times a month for preventive purposes.
  7. Exercises for the eyes. With the help of myogymnastics you can tighten and strengthen your facial muscles. 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 a preventive measure, but significant improvement is extremely rarely achieved with its help.
  8. Taking medications. If ptosis is a complication of chronic diseases, including neurological ones, 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 medications. Ptosis will disappear on its own after the disease that caused it is eliminated.

If conservative methods are ineffective, ptosis is eliminated through surgery.

Surgical methods of correction

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

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

In the case of blepharoplasty, the eyelids acquire a normal appearance immediately after the operation, and the effect lasts for a long time. Timely surgical intervention is especially important if a child suffers from ptosis. In babies, their visual organs are just developing, and drooping eyelids can have a negative impact on them, causing 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 surgeries to correct drooping eyelids.

  1. Stitching to the frontal muscle is carried out when there is insufficient mobility of the upper eyelid.
  2. Muscle resection is performed with moderate eyelid mobility and shortening of the muscle that prevents it from drooping. The surgeon makes an incision in the eyelid, removes a small area of ​​skin and cuts off part of the muscle.
  3. Duplication of the muscle aponeurosis is carried out with good mobility of the upper eyelid. To lift it, you need to shorten the muscle that controls the eyelid.

As a rule, operations are performed under local anesthesia, sutures are removed within 3–5 days, and the rehabilitation period does not cause significant inconvenience to patients. With proper intervention, relapses of ptosis rarely develop, and the person can return to their normal lifestyle.

The choice of a clinic and a specialist who will perform the operation should be approached very carefully, because unprofessional actions of a doctor can provoke a number of complications: lacrimation, eyelid inversion, sloppy scars, etc.

Reviews of the operation performed

I am 16 years old, I have congenital ptosis, I had 5 operations at the Fedorov clinic in Novosibirsk (I live in Magadan). I remember the first 4 operations vaguely, because it 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 eyebrow muscles or something. With makeup, ptosis is even less noticeable. I'm suffering. It’s still a complex, but what a complex it is. I can’t come to terms with the fact that I’ve been like this my whole life...

My son is also 3 years old; in July we had surgery 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, grade 4. Surgical treatment was performed at the age of 2 years, and levator resection was performed. 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 serious neurology, now the child is almost 6 years old, and I can say that the more he develops, the better his eyes open, i.e. there is an obvious connection between the general improvement in the child’s neurological status and the opening of his eyes. It is likely that overall nerve conduction improves, hence the wider eyes.

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

Folk remedies

Treatment with herbs and other traditional methods does not bring a noticeable effect on drooping eyelids and is justified only as preventive procedures or as an additional remedy in parallel with traditional therapy.

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

  1. Grated raw potatoes. Grate the potatoes on a fine grater, place in the refrigerator for 30 minutes, and then apply the mixture to clean eyelids. Leave the mask on for 15 minutes, then rinse it off with warm water.
  2. 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, you need to wipe your eyelids and face.
  3. 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. Wipe your eyelids with the cooled infusion 3 times a day.
  4. Ice cubes. To increase 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.
  5. Sesame oil and egg yolk. Beat the yolk of 1 egg, add half a teaspoon of sesame oil, mix well and apply the mixture to your eyelids. After 20–30 minutes, rinse off the mask with warm water.

Regular use of folk remedies can delay age-related ptosis for some time.

Folk remedies for the prevention of ptosis in the photo

Potatoes contain starch, which has a positive effect on sagging skin
Chamomile is a 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 a cosmetic and medicinal raw material. Ice cubes cool the skin, making it firmer Yolk and sesame oil - the basis of a nourishing eye mask

Prognosis and possible complications

Eyelid ptosis can be successfully treated surgically, but conservative methods may not bring the desired results. In this case, you should not postpone surgical intervention, since drooping eyelids can provoke ailments such as strabismus and amblyopia, which leads to significant deterioration of vision.

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

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

  • sore 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 lower the eyelids.

As a rule, most complications resolve within 1–2 weeks. If symptoms continue to bother you, the patient needs further examination and treatment.

Prevention

The following measures help prevent the appearance of ptosis:

  1. Timely treatment of diseases that lead to drooping eyelids (in particular, eliminating problems with the facial nerve).
  2. Myogymnastics for the eyes and facial muscles.
  3. Facial massage, including self-massage.
  4. Using folk recipes to tighten the skin of the eyelids.
  5. Regular use of masks, creams and serums with a lifting effect to prevent age-related changes.

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

Exercises to prevent drooping eyelids - video

Ptosis of the eyelid causes people a lot of inconvenience, both physical and psychological. In some cases, this problem can be eliminated using conservative methods, but more often the matter ends with surgery, especially in the congenital form of the disease. Do not be afraid of surgical intervention: provided you choose a specialist wisely, the operation will return you to an attractive appearance, and possible complications will be minimized.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is ptosis?

The term "ptosis" is translated from Greek as "drooping". Most often in medicine, the word “ptosis” refers to drooping of the upper eyelid, abbreviating the full name of this pathology - blepharoptosis. However, in some cases, the phrases “breast ptosis”, “buttock ptosis”, etc. are also used, denoting prolapse of the corresponding organs.

Most of this article is devoted specifically to blepharoptosis, which, according to long-standing tradition, is simply called ptosis. Points 8, 10, 12 discuss facial ptosis, breast ptosis and buttock ptosis.

So, blepharoptosis, or simply ptosis – organ pathology vision, which is characterized by drooping of the upper eyelid below the upper edge of the iris by 2 mm or more. The disease occurs due to a violation of the innervation of the muscle of the upper eyelid or its developmental anomaly.

Reasons for the development of ptosis

Ptosis can be congenital or acquired.

Congenital ptosis most often it is bilateral. It occurs due to the absence or underdevelopment of the muscle that lifts the upper eyelid. This happens for several reasons:

  • hereditary diseases;
  • anomaly of intrauterine development of the fetus.
Congenital drooping eyelid may be accompanied strabismus or amblyopia.

Acquired ptosis usually unilateral and occurs due to a violation of innervation levator(the muscle that lifts the upper eyelid). Acquired ptosis in most cases is one of symptoms common diseases. The main reasons for its occurrence:

  • acute and subacute diseases of the nervous system that lead to paresis or paralysis levator;
  • stretching of the muscle aponeurosis (the junction of the muscle into the tendon) and its thinning.

Types of ptosis (classification)

Acquired ptosis has its own classification and subtypes, which directly depend on the reasons that caused the pathological condition of the muscle.

Aponeurotic ptosis, in which the muscle is stretched and weakened, is divided into:

  • Involutional (senile, senile) ptosis occurs against the background of general aging body and in particular the skin. Occurs in older people.
  • Traumatic ptosis occurs due to damage to the muscle aponeurosis as a result of injury or after ophthalmic surgery. Moreover, postoperative ptosis can be either transient or stable.
  • Ptosis caused by long-term use steroid drugs.
Neurogenic ptosis occurs in the following cases:
  • Injuries that affect the nervous system.
  • Acute infectious diseases of the nervous system of viral or bacterial etiology.
  • A number of neurological diseases, e.g. stroke , multiple sclerosis and others.
  • Diabetic neuropathy, intracranial aneurysms or ophthalmoplegic migraine.
  • Damage to the sympathetic cervical nerve, which is responsible for raising the eyelid. This is one of the signs of Horner's oculosympathetic syndrome. Other symptoms of this condition are enophthalmos (recession of the eyeball), miosis (constriction of the pupil), pathology of the dilator (radially located muscle of the pupil) and dyshidrosis (impaired sweating). In children, this syndrome can lead to heterochromia - irises of different colors.
Myogenic (myasthenic) ptosis occurs in patients with myasthenia gravis with damage to the myoneural synapse (the area of ​​innervation where the nerve branches and passes into muscle tissue).

Mechanical ptosis occurs as a result of a rupture or scar in the upper eyelid, the presence of a scar in the inner or outer area adhesions eyelids, as well as due to foreign body entering the eye.

False ptosis (pseudoptosis) has several reasons:

  • excess skin folds of the upper eyelid;
  • hypotension eyeball (decreased elasticity);
  • endocrine unilateral exophthalmos.
Oncogenic ptosis occurs when a tumor develops in the orbit (orbit).

Anophthalmic ptosis manifests itself in the absence of the eyeball. In this condition, the upper eyelid does not find support and droops.

Ptosis also varies in severity:

  • 1st degree(partial ptosis) – the pupil is 1/3 closed by the eyelid;
  • 2nd degree(incomplete ptosis) – the eyelid covers 2/3 of the pupil;
  • 3rd degree(complete ptosis) – the pupil is completely covered by the upper eyelid.

Symptoms of ptosis

  • Drooping eyelid of one or both eyes;
  • sleepy facial expression;
  • constantly raised eyebrows;
  • head thrown back (“stargazer pose”);
  • strabismus and amblyopia(functional decline visual acuity), as a consequence of ptosis;
  • eye irritation, which can lead to the development of an infectious process;
  • inability to close the eye completely; this requires additional effort;
  • increased fatigue eye;
  • diplopia (double vision).

Diagnostics

In order to correctly prescribe therapy, the doctor must first establish the cause of ptosis and its type - congenital or acquired, since the method of treatment - surgical or conservative - depends on this.

Their effect is based on relaxation of the muscle that is responsible for lowering the eyelid. At the same time, the upper eyelid rises and the field of vision is normalized.

Before the procedure, the doctor must collect complete information about the patient - injuries, illnesses, medications taken. Checks availability allergies and cases of ptosis in the family.

When there are no contraindications, the exact cause of ptosis has been established and a treatment regimen has been developed, you can begin the procedure. But before this, the patient must be informed about the method, photographed and sign a consent to treatment.

The concentration of the drug is determined by the doctor during examination. Subcutaneous or intradermal injections are made with disposable insulin syringes.

The procedure lasts 5-6 minutes, the injections are almost painless. The patient is in a comfortable cosmetology chair. Before the procedure, the skin of the eyelids is disinfected, after which the doctor must mark the injection sites for the drug with dots.

At the end of the procedure, the upper eyelid at the injection sites is treated antiseptic. The patient remains under medical supervision for another 20-30 minutes.

After treatment, the patient must follow several recommendations:

  • three to four hours after the procedure, stay only in an upright position, do not bend over or lift heavy objects;
  • Do not massage or knead the injection site;
  • do not drink alcoholic beverages;
  • do not expose the injection site to high temperatures, that is, do not apply bandages or warm compresses, postpone all visits saunas, baths and solarium, since the effect of treatment may decrease or disappear.
All these restrictions will be lifted in a week. The therapeutic effect of the procedure occurs after 1-2 weeks and lasts for 6 months and up to a year, gradually weakening.

Currently, Botox treatment is an excellent alternative to surgery. This technique allows patients with partial or incomplete ptosis of the upper eyelid to cope.

Ptosis after Botox
Although the injection of Botox is used to treat ptosis of the eyelids, the same procedure, if not performed skillfully, can aggravate existing ptosis or even cause it (if Botox is injected, for example, for the purpose of smoothing wrinkles).

However, the appearance of ptosis (or an increase in its degree) after Botox is not considered a serious complication requiring treatment. Approximately a month after the Botox injection, the resulting ptosis disappears spontaneously.

Surgery

Surgery is necessary when conservative treatment methods have not given the desired result, and Botox therapy is not suitable.

It is especially important to eliminate ptosis in a child, since at this time his posture and organ of vision are developing, and if treatment is refused, various complications may arise. Moreover, the sooner ptosis is diagnosed and treated, the better.

Treatment of congenital ptosis involves shortening the muscle that lifts the upper eyelid, and treatment of acquired ptosis involves shortening the aponeurosis of this muscle.

The operation is performed under local or general anesthesia and lasts from 30 minutes to an hour. The wound is sutured with cosmetic sutures, so the scars are practically invisible. The stitches are removed after a week.

After surgery on wound an aseptic bandage is applied, which is removed after 2–4 hours. The wound is not painful, so most often patients analgesics dont need.

The operations themselves are divided into three groups:

  • Hess operation, in which the function of the levator (the muscle that lifts the upper eyelid) is transferred to the frontal muscle using suturing; this operation is performed only for paralysis of the levator and superior rectus muscles;
  • Mothe method– the levator function is enhanced by the superior rectus muscle, if it is not paralyzed; the operation is technically complex, so many cosmetology clinics do not undertake it;
  • Eversbush operation– duplication (formation of a fold) on the aponeurosis (tendon) of the levator; This is the most common method of surgical treatment of ptosis, especially its modification - the Blaškowicz operation.
Technically, the course of the simplest surgical operation can be described as follows:
1. To raise the upper eyelid, it is necessary to perform a resection (excision) of the muscle; with a shortened muscle, the eyelid will not lower spontaneously; To do this, a small incision is made, a small part of the muscle and skin is removed, after which everything is stitched together with cosmetic stitches. Before use, you should consult a specialist.