Ptosis refers to the upper eyelid margin being lower than the normal anatomical position, partially or completely blocking the pupil, affecting visual function and appearance. It is one of the common eye diseases. According to the pathogenesis and clinical manifestations, it can be divided into two categories: congenital and acquired. Different types have significant differences in diagnosis and treatment. This article systematically expounds on four aspects: symptom manifestations, classification basis, diagnostic methods and treatment strategies, in order to provide a reference for related clinical research and practice.
1. Symptoms
The main symptom of ptosis is the abnormal drooping of the upper eyelid . The appearance shows asymmetry of the eyes, difficulty in opening the eyes, and limited visual field. The patient may have difficulty opening the eyes, frowning on the forehead, and tilting the head back to compensate for the blocked vision. The degree of ptosis can be divided into mild, moderate and severe:
Mild ptosis : The upper eyelid covers the upper edge of the cornea but does not cover the pupil;
Moderate ptosis : The upper eyelid covers the upper edge of the pupil;
Severe ptosis : The upper eyelid covers the entire pupil, seriously affecting visual function.
Accompanying symptoms may include visual fatigue, dry eyes, diplopia (especially when it involves oculomotor nerve dysfunction), blurred vision or strabismus in some patients, and long-term unilateral ptosis can lead to amblyopia and visual development disorders , especially in children.
2. Classification basis
Congenital ptosis
Such patients usually show abnormal eyelid position since birth. The main cause is the incomplete development of the levator palpebrae superioris muscle. Its clinical characteristics are unilateral or bilateral ptosis, limited eye opening but normal eye movement, and some cases are accompanied by nystagmus, strabismus or other eye deformities.
Etiology : It is often related to abnormal embryonic development, such as incomplete development of the third cranial nerve nucleus or poor development of the muscles themselves.
Acquired ptosis
Acquired ptosis can be divided into the following categories according to the different causes:
Neurogenic : common in oculomotor nerve palsy, Horner syndrome, myasthenia gravis, etc. This type of ptosis is accompanied by eye movement disorders or other neurological signs.
Myogenic : more common in ocular muscular dystrophy and chronic progressive external ophthalmoplegia, manifested as symmetrical and progressive ptosis.
Aponeurotic : also known as degenerative ptosis, it is a common type in the elderly, caused by degeneration of the levator palpebrae superioris aponeurosis. Usually there is no eye movement disorder and the eye opening function is better.
Mechanical : Passive ptosis of the eyelids due to eyelid or orbital tumors, scar contracture, thickening of the tarsal plate, etc.
Traumatic : ptosis caused by eye trauma or postoperative damage to the levator palpebrae superioris muscle structure.
3. Diagnostic Methods
The diagnosis of ptosis mainly relies on clinical examination and auxiliary tests.
History and physical examination
The doctor needs to inquire in detail about the onset of the disease, the rate of progression, the presence or absence of a history of trauma or surgery, and the presence of complications. Visual examination can provide a preliminary assessment of the degree of ptosis and its impact on the visual axis.
Functional assessment
Upper eyelid levator muscle function test : measure the maximum range of motion of the upper and lower eyelids before and after direct gaze;
Eye opening measurement : the vertical distance from the upper eyelid margin to the center of the cornea, normally 10–12 mm;
Judgment of compensatory activity of the frontalis muscle : If the function of the levator muscle is poor, compensatory contraction of the frontalis muscle is common.
Testing
Ice test and neostigmine test : used to screen for myasthenia gravis;
Eye movement examination and MRI : used to exclude oculomotor neuropathy or intracranial lesions;
Electromyography and genetic testing : assist in the diagnosis of myogenic diseases;
Fundus examination and visual function assessment : rule out retinal or optic nerve damage.
IV. Treatment Strategies
The treatment goal of ptosis is to restore normal eye opening function, improve appearance, and protect visual function . The treatment method depends on the cause and degree of ptosis, and is mainly divided into conservative treatment and surgical treatment.
Conservative treatment
Suitable for patients with stable condition, acceptable function, or short-term symptoms (such as myasthenia gravis and some neurological diseases):
Drug treatment : such as acetylcholinesterase inhibitors (for muscle weakness);
Occlusion training and amblyopia correction : used to prevent visual development disorders in children;
Regular observation : Surgery can be delayed for patients with mild disease and no progression.
Surgery
When the degree of ptosis affects vision or appearance significantly, surgical intervention is considered. Common surgical methods include:
Levator palpebrae superioris muscle shortening surgery : suitable for patients with preserved levator muscle function;
Frontalis muscle flap suspension : used for patients with severe loss of levator muscle function, lifting the upper eyelid by frontalis muscle traction;
Aponeurosis folding or reconstruction : suitable for aponeurosis ptosis;
Scar release and blepharoplasty : for mechanical ptosis.
Before surgery, binocular vision, palpebral fissure height, corneal protection function and patient needs should be fully evaluated. After surgery, one should be alert to complications such as exposure keratitis and incomplete eyelid closure.
5. Prognosis and daily management
Most cases of ptosis can recover well after proper treatment, but if there is an underlying disease, such as muscle weakness or neuropathy, long-term follow-up and disease management are required. Child patients should receive early intervention to prevent the formation of irreversible amblyopia.
Beauty Encyclopedia Tips:
Ptosis not only affects appearance, but may also cause visual dysfunction. Early detection, scientific evaluation and individualized treatment are the key to improving prognosis. In daily life, if you find difficulty opening your eyes, asymmetry of the eyes, or blocked vision, you should see an ophthalmologist in time for a clear diagnosis. Do not blindly accept non-professional cosmetic interventions. Adequate preoperative evaluation and standardized postoperative care are essential to maintaining the effectiveness of the surgery.