Ptosis is a common eyelid disease, the main manifestation of which is that the upper eyelid edge is lower than the normal level, partially or completely covering the pupil , affecting the appearance and vision. The disease can occur unilaterally or bilaterally, with varying degrees of severity. It can be congenital or acquired. Understanding the cause, classification, clinical manifestations and treatment methods of ptosis is of great significance for clinical diagnosis and treatment.
1. Classification of etiology
Based on the pathogenic mechanism and time of occurrence, ptosis is usually divided into two categories: congenital and acquired .
1. Congenital ptosis
Congenital ptosis is mostly caused by developmental abnormalities. The most common cause is poor development or absence of the levator palpebrae superioris muscle . Most patients with this type of ptosis have symptoms at birth. The ability of the affected eyelid to lift is limited, often accompanied by eye movement disorders, such as limited upward rotation or strabismus. Some patients may have other congenital syndromes, such as Blepharophimosis syndrome and Marcus Gunn phenomenon.
(ii) Acquired ptosis
Acquired ptosis is divided into the following categories according to the location of the lesion:
Neurological : such as oculomotor nerve palsy, Horner's syndrome, etc., which lead to dysfunction of the nerves that control the levator palpebrae superioris muscles.
Myogenic : Muscle diseases such as myasthenia gravis and ocular muscular dystrophy affect the function of the levator palpebrae superioris muscle itself.
Aponeurotic : Mainly caused by degenerative changes or rupture of the levator palpebrae superioris aponeurosis, it is common in middle-aged and elderly people.
Mechanical : Tumors, inflammation or trauma cause the weight of the upper eyelid to increase, resulting in passive ptosis.
Traumatic : Injury to the levator muscles following eyelid surgery or trauma.
2. Clinical manifestations
The typical manifestation of ptosis is the abnormal lowering of the upper eyelid edge . Patients have difficulty opening their eyes. In severe cases, the pupil is covered, affecting vision . The following aspects should be paid attention to during clinical evaluation:
Degree of ptosis : It can be divided into mild (covering 1-2mm of the upper edge of the cornea), moderate (covering the middle of the cornea), and severe (covering the pupil or the entire cornea).
Evaluation of levator muscle function : The functional status of the levator muscle is determined by measuring the distance of eyelid movement from downward gaze to upward gaze.
Compensatory actions : Some patients maintain their sight by raising their eyebrows, tilting their head back , etc.
Vision and refractive status : Especially in children, long-term ptosis may induce amblyopia or astigmatism.
Associated symptoms : such as eye movement disorders, pupil abnormalities, narrowing of the palpebral fissure, changes in light reaction, etc.
3. Diagnostic Methods
The diagnosis of ptosis relies on a detailed medical history, physical examination, and necessary auxiliary examinations , including:
Medical history collection : ask about onset time, history of trauma, family history, associated symptoms, etc.
Physical examination : including palpebral fissure height, levator muscle strength, eye movement, pupil status, distance from upper eyelid edge to corneal reflection point (MRD1), etc.
Auxiliary examinations : Electromyography, CT or MRI examinations can help identify nerve or muscle lesions; when myasthenia gravis is suspected, neostigmine test, AchR antibody test, etc. can be performed.
IV. Treatment Methods
The goal of treating ptosis is to improve appearance, enhance visual function, and prevent amblyopia . The specific treatment method is based on the cause and degree of ptosis.
1. Conservative treatment
It is suitable for mild, stable or reversible ptosis . For example, myasthenia gravis can be controlled by drug treatment. Child patients need regular examinations, and if there is a risk of amblyopia, therapeutic intervention should be taken as soon as possible.
2. Surgical treatment
Surgery is the main treatment for most patients with moderate to severe ptosis . Different surgical procedures are selected according to the function of the levator muscles and the degree of ptosis:
Levator palpebrae superioris muscle shortening surgery : suitable for patients with moderate or good levator muscle function, it can lift the eyelid position by shortening the aponeurosis.
Frontalis muscle flap suspension : Suitable for patients with poor or absent levator muscle function, using the power of the frontalis muscle to drive upper eyelid movement.
Combined surgical procedures : Some patients require combined strabismus correction surgery, blepharoplasty, etc. to improve overall appearance and function.
Before surgery , factors such as corneal protection function, risk of dry eye, and frontal muscle strength need to be evaluated . After surgery, attention should be paid to symmetry, eye opening and closing function, scar healing, etc.
5. Prognosis and precautions
The prognosis of ptosis is closely related to the cause, timing of treatment, and choice of surgical procedure . If congenital ptosis is not treated in time, it can easily cause amblyopia and facial developmental abnormalities. Acquired cases require vigilance as to whether they are manifestations of systemic diseases. Although surgery can improve appearance and visual field, there may be complications such as postoperative asymmetry, recurrence, and incomplete closure. Therefore, postoperative follow-up and functional training are also very critical.
Beauty Encyclopedia Tips:
Ptosis not only affects the appearance of the face, but may also cause damage to visual function. It is especially important to pay attention to it in children. If abnormal eyelid movement is found, medical evaluation should be sought as soon as possible to determine the cause. For adults, ptosis accompanied by abnormalities of the nervous or muscle system may indicate underlying diseases, and related lesions should be systematically checked and excluded. Although surgical treatment can effectively improve symptoms, it also requires a comprehensive assessment of eyelid function and facial coordination, and a personalized plan should be developed by a professional doctor. At the same time, maintaining eye health, paying attention to eye hygiene, and avoiding eyelid injury can also help delay or prevent the progression of ptosis.