Congenital ptosis of the upper eyelid degree. Upper eyelid ptosis - causes in adults

Unilateral ptosis occurs much more often than bilateral. However, first of all, mention should be made of a frequently made mistake: eyelid retraction on the other is often mistaken for dropping the eyelid on one side. In the latter case upper eyelid does not reach the upper edge of the iris. In this case, it is necessary to conduct a diagnostic search in relation to endocrine ophthalmopathy, as well as exophthalmos with a volumetric process in the orbit (when looking down, the upper eyelid remains in place), inflammation or pathological filling of blood vessels (angioma, venous sinus thrombosis, etc.). If true unilateral ptosis of the eyelid is detected, the analysis is carried out in accordance with the principles below.

Unilateral ptosis of the eyelid observed from birth:
If he wears permanent character, may be based on:
- Benign unilateral congenital ptosis of the eyelid: as a rule, it is not of a family nature, does not progress and is not accompanied by other pathological changes in the eye.

Horner's congenital syndrome: in this case, miosis, vasodilation of the conjunctiva, weakening of sweat reactions on the face should be detected. Enophthalmos is often subtle. In Horner's syndrome, ptosis is more noticeable when looking down rather than up (as opposed to a partial lesion oculomotor nerve). It can be a sign of perinatal injury. The iris is often light colored.

If Horner's syndrome is accompanied by signs of root damage, it may be based on brachial plexopathy associated with birth trauma. Often, anisochromia of the iris is also observed, with a lighter shade on the affected side.

If there is an isolated Horner syndrome, which is nevertheless accompanied by a violation of the secretion of the sweat glands on the face, the cause may be damage to the borderline trunk in the region of the stellate ganglion or sympathetic plexus around the internal carotid artery (for example, hematoma).

If the severity of ptosis of the century changes, we can assume:
- the phenomenon of palpebromandibular synkinesis (symptom of Marcus Hun). It is a congenital ptosis that disappears when the mouth is opened and especially when the chin is moved to the sides. The reason is the formation of a pathological connection between the nuclei of the oculomotor and trigeminal nerves.
- Duane Syndrome, which is based on a pathological connection between the abductor and oculomotor nerves: when looking to the side in the abducted eye, retraction of the eyeball becomes noticeable (possibly associated with the simultaneous innervation of the rectus internal muscle), which causes narrowing of the palpebral fissure or ptosis.

Unilateral ptosis of the eyelidthat appeared during life:
Further stage of diagnostic search it is necessary to find out whether the ptosis of the eyelid is progressive or stationary in nature and is accompanied by other disorders of the eyes or nervous system.

Fully isolated unilateral eyelid ptosis is permanent or progressive. A similar symptom is observed:
- with a pathological process in the eye socket or eyelid disease;
- with an isolated lesion of the upper muscle of the eyelid cartilage (m. tarsalis superior) or its innervating terminal sympathetic branches, which sometimes happens after recurrent infectious lesions of the conjunctival sac, but can develop without a reason; ptosis can decrease after instillation of 10% phenylephrine solution into the conjunctival sac;

With the defeat of the striated muscle that lifts the upper eyelid, or the branches of the oculomotor nerve that innervate it. In clinical practice, such an isolated symptom is extremely rare.

Unilateral permanent or progressive ptosis that is accompanied by other eye or nervous system symptoms.
- Unilateral ptosis due to damage to the oculomotor nerve is always associated with impaired eye movement, as well as mydriasis. In this case, doubling may be absent, since the affected eye does not see due to ptosis. Ptosis with lesions of the oculomotor nerve, in contrast to Horner's syndrome, becomes more pronounced when looking up. In peripheral lesions, ptosis is usually an early sign, when the area of \u200b\u200bthe nuclei is damaged, it is preceded by a progressive weakness of the eye muscles ("the curtain falls at the end").
- With hemiatrophy of the face, along with other signs of damage to the muscles of half of the face, ptosis of the eyelid often develops.
- Unilateral ptosis associated with arteriovenous malformation of the contralateral frontal lobe has been described as rare symptom... After the operation, he regresses.

Unilateral ptosis observed sporadically or its severity changes. The underlying causes may be the same as for bilateral remitting ptosis:
- first of all - myasthenia gravis;
- unilateral ptosis can develop as part of Horner's intermittent syndrome with migraine attacks or erythroprosopalgia. In some patients with cluster headache, ptosis or Horner's syndrome also occurs outside the headache attack.

Unilateral ptosis in Horner's syndrome accompanied by miosis, increased injection of vessels of the conjunctiva and mild enophthalmos. Horner's syndrome is a sign of a violation of the sympathetic innervation of the eye. The anatomical substrate of this pathology is shown in the figure. Etiological factors are identified based on the history and / or associated neurological symptoms:
- If a lesion of the central sympathetic pathway is observed due to any pathological process, Horner's syndrome is accompanied by signs of brain damage. The central sympathetic pathway probably originates in the hypothalamus and reticular formation, passes ipsilaterally, closer to the midline, from the aqueduct and IV ventricle, through midbrain and the pons of varoli, then, slightly deviating to the side, through the posterior parts of the medulla oblongata into the spinal cord. A lesion in the ventral midbrain, which also extends to the thalamus, may be accompanied by the development (homolaterally) of Horner's syndrome and contralateral movement disorders.

It is curious that at the same time, on the side of the manifestations of Horner's syndrome, a weakening is sometimes observed, and on the opposite side - an increase in the secretion of sweat glands (the so-called alternating autonomic hemiplegia). The classic case is Horner's syndrome as part of Wallenberg's syndrome (a lesion in the posterolateral regions of the medulla oblongata). With spontaneous dissection of the internal carotid artery, Horner's homolateral syndrome (due to lesions of the periarterial sympathetic plexus) may be accompanied by contralateral hemiparesis.

Horner's syndrome accompanied by signs of damage to the roots of C8-Th2 (for example, in case of rupture after shoulder injury, paravertebral neoplasm, etc.). In this case, there is no violation of the secretion of sweat glands.

Horner's syndrome accompanied by damage to the lower part brachial plexus... It is usually not easy to do this. differential diagnosis with damage to the nerve roots. In most cases, a tumor of the apex of the lung (for example, Pancost's tumor) is the basis, and Horner's syndrome develops due to a violation of the function of the border sympathetic trunk. Moreover, it is always accompanied by a homolateral violation of the secretion of sweat glands on the face and upper quarter of the body, which is not observed with the defeat of the C8-Th2 roots. Horner's syndrome is accompanied exclusively by signs of damage to the sympathetic borderline trunk. These include impaired secretion of sweat glands and vasomotor regulation of pyloric reactions.

At first glance, ptosis, that is, drooping of the upper or lower eyelid, seems to be a common cosmetic defect. In fact it is serious illness, which can develop for various reasons and have negative consequences.

What is the disease

Translation of the term "ptosis" means "fall", and this is how the disease manifests itself - drooping of one or two eyelids, upper or lower. Such an incorrect position of the eyelid can partially or completely cover the eye, while normally the iris is covered by the edge of the eyelid by about one and a half millimeters. About blepharoptosis (prolapse upper eyelid) we can say if the iris is covered by the eyelid by more than 2 millimeters.

The disease can be congenital or acquired, so it occurs at any age, in children and adolescents as well. The drooping eyelid mechanically complicates vision, the work and development of the visual analyzer, so the disease is fraught with many complications, especially for young children. To children, the disease is most often inherited, and in adults it develops due to a variety of reasons of a mechanical, neurogenic, traumatic nature.

Video - Details about ptosis

Classification

According to the time of the onset of the disease, congenital and acquired ptosis of the eyelid is distinguished. Pathology can be unilateral, that is, the eyelid of one eye is drooping, which occurs in 70% of all cases of the disease. With a bilateral form, both eyes are affected, such a lesion is observed in 30% of cases.

Depending on the reasons that provoked the disease, several types of acquired ptosis are distinguished:

• mechanical;
• aponeurotic:
  • involutional (senile);
  • traumatic;
  • against the background of long-term steroid use;
• neurogenic;
• myogenic (myasthenic);
• oncogenic;
• anapthalmic;
• false (pseudoptosis).

Why pathology occurs

The eyelid is raised thanks to the work of a special muscle - the levator, which is controlled by the oculomotor nerve. Therefore, the main reasons for the development of the disease are anomalies of the muscle itself or nerve pathology.

Congenital arises either due to underdevelopment or aplasia, that is, the complete absence of a levator, or is associated with an abnormal development of the nerve. Such violations most often occur due to heredity or pathology of pregnancy and childbirth. Congenital drooping of the eyelid is rarely an isolated disease, often accompanied by amblyopia ( lazy eyewhich leads to loss of vision), strabismus, anisometropia (impaired refraction of the eye, leading to strabismus or visual weakness).

Acquired often develops on the one hand and is one of the signs of common diseases:

• The aponeurotic type of blepharoptosis occurs due to weakness or excessive stretching of the aponeurosis (broad tendon plate) of the levator. This can occur due to involutionary changes that begin with the advent of old age, as well as injuries or damage to the plate during operations.
• The neurogenic (neurogenic) type of the disease is a consequence neurological diseases:
  • inflammation of the meninges;
  • stroke;
  • multiple sclerosis;
  • paresis (partial paralysis) of the oculomotor nerve;
  • diabetic neuropathy;
  • ophthalmoplegic migraine;
  • bernard-Horner syndrome (characterized by a number of symptoms, including cervical nerve palsy).
• Myogenic prolapse of the eyelid occurs as a complication of myasthenia gravis (muscle weakness), dystrophy of muscle tissue, congenital myopathy, blepharophimosis.
• Mechanical ptosis can occur due to trauma to the orbit of the eye, injury, scar of the eyelid, as a complication after cosmetic procedures, in particular, the introduction of Botox.

The procedure for rejuvenation through the introduction of botulinum toxin requires experience and caution from the doctor; if the strict technology of manipulation is not followed, a ptosis of the eyelids of a pronounced degree may develop when the eyeball is completely closed by the eyelid. With the introduction of the drug, the nerve endings in the muscle tissue are blocked, the muscle fibers are completely relaxed and the wrinkles are gradually smoothed. An incompetent physician may inject too much of the drug, which then gets into the tissues of the upper eyelid and causes it to prolapse.

• If a neoplasm develops in the orbital area, then oncogenic ptosis develops, in the absence of an eyeball - anapthalmic.
• False ptosis (pseudoptosis) occurs with blepharochalasis (stretching and atrophy of the eyelid skin), strabismus, hypotension (reduced elasticity) of the eye.
• The lower eyelid most often drops as a result of previous operations or injuries.

In children, the disease can be, as in adults, congenital or acquired. The main reasons for drooping eyelids in babies:

• birth trauma;
• dystrophic myasthenia gravis (muscle weakness);
• neurofibroma or hemangioma;
• ophthalmoparesis (incomplete paralysis of the eye muscles);

Congenital drooping of the eyelids in babies most often has a neurogenic nature and occurs when certain nerves are paresis; it can be dystrophic in nature and arise due to an anomaly of the eyelids and underdevelopment of the levator. Myogenic ptosis is inherited by children.

Acquired ptosis in children can be caused by various neurological diseases, injuries, tumors, for example, of the thymus gland, while the myogenic type of the disease develops.

Disease symptoms

Manifestations of blepharoptosis are easy to notice: the eyelid partially or completely covers the eyeball.
When the lower eyelid drops, its edge is so much lower than the iris that it opens a significant part of the sclera of the eye, while the person has a characteristic tired appearance.
Patients with blepharoptosis are forced to strain their forehead, arch their eyebrows, or raise their chin to improve their vision. This characteristic position of the patient with his head thrown back is called the "astrologer pose". Difficulty in blinking movements provokes rapid fatigue, irritation, overdrying and infection of the eyes.

Acquired ptosis is often accompanied by diplopia (double vision), impaired vision, impaired sensitivity of the cornea, exophthalmos (bulging of the eyeball), or enophthalmos (the opposite of exophthalmos).

The drooping of the eyelids can be of varying degrees. If the disease is not treated, then it progresses to the complete omission of the eyelid.

Table - the degree of the disease

Diagnostics

Ptosis is not an isolated disease, so an ophthalmologist and a neurologist are involved in diagnostics. The main task of doctors is to find out the nature of the disease, what caused the drooping of the eyelids, in order to choose the correct treatment tactics.
Diagnostics begins with an external examination, assessment of the severity of ptosis, eye asymmetry, palpebral fissure width, condition of skin folds, eye mobility, eyebrows, head position.

Special ophthalmic tests are performed:

• test of visual acuity;
• perimetry - definition of visual fields;
• biomicroscopy - examination of all structures of the eye using a slit lamp.

If necessary, the patient is measured the intraocular pressure, the angle of strabismus, a study of convergence is carried out, that is, the consistency of eye movement.
In case of injuries that caused the development of mechanical ptosis, an X-ray of the orbit is performed in order to determine the location of the injury.
To confirm or exclude the neurogenic nature of the disease, an MRI or CT scan of the brain is performed.

Treatment of the disease

The goal of therapy is to eliminate the causes that caused the drooping of the eyelid and to correct the cosmetic defect. The patient can be offered conservative treatment based on physiotherapy.

Conservative therapy

If the disease is acquired in nature, then the underlying disease is treated and physiotherapy is used. The effect of such therapy can only be in the case of neurogenic ptosis.

Physiotherapy for the treatment of drooping eyelids:

• galvanotherapy - current treatment has a stimulating effect;
• UHF - brings good results with neurogenic ptosis;
• electrophoresis with drugs necessary to treat the underlying disease;
• myostimulation is good for age-related ptosis to strengthen the skin and subcutaneous tissues;
• paraffin therapy - applications with paraffin are effective for myopathy, paresis.

For the treatment of partial ptosis that develops with age, the patient is sometimes recommended cosmetic products with a lifting effect, which must be used for a long time. Such funds do not always bring good results, creams and ointments can serve more as a prevention of pseudoptosis.
To maintain the upper eyelid, doctors sometimes recommend fixing it with adhesive tape. This method is temporary and can be used in children and adults until the time the surgery is performed.
Massage and special exercises can stop the development of the disease and help to early stages.
To strengthen the eyelids, daily massage is recommended for a course of 10-15 days, then a week break and a second course of the same duration.

The massage is carried out with closed eyes with a cotton pad or tampon, which can be soaked in cosmetic oil with the addition of vitamins or cream. The eyelids need to be stroked, massaged in circular smooth movements from the inner to the outer corner of the eye. Alternate stroking with light beating with fingertips. In addition to the eyelid, you need to massage the area around the eyes to strengthen the skin and stimulate blood circulation.

Gymnastics to strengthen the eyes and weak muscles (each exercise must be repeated up to 10 times):

1. Without moving your head, raise your eyes up, then down.
2. Make circular movements with your eyes - clockwise and counterclockwise.
3. Look left, then right.
4. Stretch your hand forward, without looking up, look at the tip of your finger, slowly bring your finger closer to your face until the image begins to double.
5. Press your finger to the bridge of your nose, alternately look at it with your left or right eye.
6. Blink quickly for 15 seconds, then a short break and repetition.
7. Close your eyes for a few seconds, sharply open your eyes.
8. Move your gaze from the farthest point to the one closest to the eyes and vice versa.

You need to do this exercise for the eyes every day for at least 3 months. You should not expect a serious improvement, exercises have a more prophylactic effect than a curative one.

Video - exercises for drooping eyelids

Surgery

If there is no effect of conservative therapy within 6-9 months or drooping of the eyelid is congenital, then the patient is assigned an operation.
Children with partial ptosis without impaired visual function are operated on after puberty, when the facial bones are already fully formed. Complete congenital ptosis is removed surgically as soon as the child is 3 years old. It is impossible to delay the operation, since the preschooler has a high probability of developing amblyopathy and other complications.
The methods of performing the operation for congenital and acquired forms are different. In the first case, the surgeon shortens the muscle - the eyelid lifter, in the second - shortens the levator aponeurosis. The operation is performed under general or local anesthesia and takes a total of 30 minutes to an hour.

If the eyelid prolapse is acquired, the operation is performed in this way:

1. The surgeon makes an incision and partial removal of the upper eyelid skin.
2. Cuts the levator aponeurosis.
3. Excises part of it and stitches it below.
4. Sutures the wound.

The congenital form is operated according to the following method:

1. The skin of the upper eyelid is incised and partially removed.
2. The levator muscle is shortened by stitching.
3. The wound is sutured.

If the congenital prolapse is significant, the eyelid lifter muscle is sutured to the muscle tissue of the cranial vault so that the patient can open the eye with the effort of the frontal muscles.
After the operation, a bandage is applied to the eye, which can usually be removed after a few hours.
The stitches are removed for 4-5 days, rehabilitation period lasts 1–2 weeks, during this time postoperative edema and hematomas disappear.

Eye rinsing is usually done after surgery antiseptic solutions, laying for the conjunctiva of eye ointments (Dexa-Gentamicin, Tetracycline, Erythromycin) twice a day, instillation antibacterial agents (Ofloxacin, Gentamicin) three times a day.
The results of the operation are usually favorable, the effect of such treatment remains for a long time, practically until the end of life.

Surgical intervention is contraindicated in some cases, namely:

• if the child is less than 3 years old;
• if there are severe pathologies of the heart and blood vessels;
• in the acute period of infectious diseases;
• with a sharp suppression of immunity;
• with mental disorders.

Folk recipes

It should be noted that the treatment of ptosis folk remedies not very effective and can only be used in the early stages and for prevention.
Firming masks and oil massages can be used to strengthen the skin of the eyelids.

Egg mask

1. Beat the raw egg yolk lightly, add 5 drops to it vegetable oil (sesame, peach or olive).
2. Apply the mass to the skin of the eyelids, leave for 15 minutes, then rinse with warm water.

Potato mask

1. Grate raw peeled potatoes, let stand for some time in a cool place.
2. Put potato cakes on the eyelids, wash after 15–20 minutes with cool water.

Rosemary and lavender compress

1. Take a large spoonful of each herb, pour boiling water (0.5 liters) and leave for 2-3 hours.
2. Moisten a napkin or cotton pad with a ready-made infusion, apply to the eyes for 10 minutes.
3. Make such compresses 2-3 times a day.

By the same principle, you can make lotions from parsley infusion (you can take both dry and fresh raw materials) and chamomile flowers.
Well increase skin elasticity by rubbing with ice cubes. For a greater effect, you can use a frozen decoction of birch leaves, fresh cucumber juice or chamomile infusion.
Traditional methods help to slow down the development of aponeurotic (age-related) drooping of the eyelids for a while. Chamomile infusion with drooping eyelids can be used in compresses or make cosmetic ice To give the skin of the eyelids, apply egg yolk with sesame or olive oil in the form of a mask
Cosmetic ice is widely used to prevent drooping of the eyelids.

Prognosis, complications, possible consequences

After surgical treatment carried out in a timely manner, the prognosis is favorable. If the cause of ptosis is a neglected neurological disease, then the effectiveness of therapy may be insufficient. If left untreated, drooping of the eyelid over time can lead to amblyopia and a significant decrease in vision. Persistent unilateral complete ptosis and irreversible loss of visual acuity is the basis for a grade 3 disability. With bilateral complete ptosis with decreased vision after all necessary treatment measures establish group 2 disability.

Preventive actions

In order to prevent drooping of the eyelids as a result of neurological diseases, it is necessary to timely examine and treat the identified pathologies. Age-related changes can be counteracted with preventive massage and strengthening the eyelids and eyeballs exercise. In children, the prevention of complications of ptosis is a timely surgical operation.

Ptosis is an unpleasant condition that causes physical and psychological discomfort. but modern medicine in most cases, it is able to cope with the symptoms of pathology and give the eyes beauty and health for long years... It is important to start treatment on time and not be afraid of surgery.

Ptosis of the upper eyelid, the causes of which may lie in heredity or external factors - this pathological condition, in which the eyelid drops and covers the eye. This ophthalmic disease is more common in old age, but sometimes occurs in young people, adolescents and even newborn children.

Normally, the iris of the eye is covered by the upper eyelid by 1-1.5 mm. Ptosis of the eyelid is diagnosed if the iris is covered by 2 mm or more. The pathology can be slightly noticeable or extremely pronounced when a person cannot open their eyes. There are three types of ptosis:

• Partial - the eyelid closes the pupil by a third;
• Incomplete - closing the pupil by half;
• Full - closing the entire pupil or the entire eye.

Doctors classify the disease by location. This is the case for unilateral ptosis - on one eyelid, and bilateral - on both upper eyelids. The unilateral form of the disease is most often acquired, and the bilateral form is hereditary. Examples can be seen in the photo on this page.

The reasons for the development of ptosis are varied, but they are always associated with one of two disorders:

• Abnormalities in the function of the oculomotor nerve;
• Levator pathology (eyelid muscles).

It is they who provide the opening of the eye and support the eyelid in the desired position. Failure of one of these elements or both at once leads to the fact that a person cannot fully open his eyes and look straight ahead.

Genetic causes of upper eyelid ptosis

If the drooping of the eyelid is caused by heredity, then it is noticeable already in the first days of life - one or both eyelids do not open in newborns. If drooping of the eyelid is present in one of the parents, the child is also likely to develop this pathology.

Pathologies of the nucleus of the oculomotor nerve and underdevelopment of the levator muscle are also genetically transmitted, therefore, an accurate diagnosis and establishment of the causes are possible only after a thorough examination.

With congenital ptosis, weakness of the superior rectus muscle of the eye is sometimes observed. When looking down in such people, the affected eyelid stops for more high level compared to healthy.

Palpebromandibular syndrome

This rare disease is genetically transmitted and causes drooping of the eyelids.

Most often, ptosis in this case is unilateral, but there are exceptions. Palpebromandibular syndrome is characterized by synkinetic retraction. The ptosis eyelid rises during the tension of the chewing muscles. This is due to the fact that when chewing, a signal is sent to the eyelid affected by ptosis through trigeminal nerve... This pathology can be accompanied by amblyopia (lazy eye syndrome) as well.

Blepharophimosis and drooping of the upper eyelid

Blepharophemosis is a rare genetic disease, in which the size of the eyelids is significantly reduced vertically and horizontally. As a result, they become taut and cannot fully open and close. The eye slit is shortened, sometimes eversion of the lower eyelid develops.

With blepharophemosis, ptosis always develops in both eyelids. The oculomotor nerves in these patients are usually well developed, but the muscle that holds the eyelid in an elevated position is weakened or atrophied.

Acquired causes of ptosis

Acquired ptosis is much more common than genetic ptosis and is classified as follows:

• Neurogenic (neurological);
• Myogenic;
• Aponeurotic;
• Mechanical ptosis.

Neurogenic causes

In this case, we are talking about paralysis of the oculomotor nerve. Modern neurology has data on the following causes of neurogenic ptosis:

• Tumors that compress the nerve;
• Diabetic neuropathy;
• Extraocular muscle pathology;
• Intracranial aneurysms;
• Ophthalmoplegia.

Myogenic causes

These reasons most often mean the syndrome of pathological muscle fatigue.

The severity of ptosis with myasthenia gravis changes during the day. After physical activityas a rule, at the end of the day, the eyelids drop, and in the morning they open wider than in the evening. Some patients notice a split image after exercise.

It is noteworthy that endorphin allows diagnosing ptosis caused by myasthenia gravis. When it affects the human body, the drooping of the eyelids becomes less pronounced.

Aponeurotic causes of ptosis

Most often, ptosis of aponeurotic origin is observed in the elderly. The tension and fixation of the eyelids disappears for the reason that the tendon that understands it gradually separates from the plate on which it is fixed. Aponeurotic ptosis can develop not only by age reasons, but also due to injury.

Mechanical causes of ptosis of the upper eyelid

This category includes all injuries, surgical interventions and other influences that have caused scarring of the eyelid tissue. Due to the appearance of scars, the eyelid is shortened horizontally, which causes its tension and the impossibility of full lifting. Also, mechanical ptosis can be provoked by tumors. Such an omission passes by itself over time.

Acquired ptosis can be artificially induced for medicinal purposes. This is necessary for corneal ulcers due to lagophthalmos. With this pathology, a person cannot close his eyes, which causes damage to the cornea.

Upper eyelid ptosis treatment

The drooping of the upper eyelids is amenable to conservative treatment. The following methods are used:

• Massage;
• Ultra-high-frequency physiotherapy (exposure to a high-frequency electromagnetic field);
• Galvanization (exposure to a constant electric current on damaged eyelid tissues);
• · Drug therapy (drugs that feed the nervous tissue);
• Therapeutic gymnastics (exercises for pulling up weakened oculomotor muscles).

Ptosis of the upper eyelid. Home treatment

Self-massage is prescribed for home treatment. It is especially effective in the treatment of children and adolescents. The massage is performed in the following sequence:

• Training. It is necessary to carefully examine the skin of the eyelids, make sure that there is no redness, irritation and abscesses. If not, wash your face with soap and dry your face with a towel. Next, apply a little oily cream on the eyelids, lubricate the eyebrow area well with it;
• Start of massage. Stroke the skin around the eyes with your index fingers without touching the eyelid. Run lightly over the eyebrows. Repeat the above steps five times and blink for a few seconds;
• The main stage of the massage. Rub your hands until they are warm. With your index fingers, lightly press the place between the eyebrows and slide along them to the outer sides. Repeat 10-15 times;
• End of massage. Lightly stroke the skin around the eyes with stroking movements.

Therapeutic gymnastics for the treatment of ptosis

In the proposed video, see exercises for upper eyelid ptosis.

This treatment is effective in congenital ptosis in young children. It aims to strengthen the muscles of the upper eyelids. Gymnastics is performed as follows:

1. Warm up. Make circular movements with wide eyes, squint strongly, but do not close your eyes. Stay in this position for a few seconds. Repeat five to six times;

2. First exercise. Close your eyes tightly for 10 seconds, then relax. Repeat 10 times;

3. Second exercise. Place index fingers on eyebrows and press down slightly. Overcoming the strength of the fingers, you need to try to bring your eyebrows together, but do not allow the formation of a fold between them. Repeat several times, become if muscle pain occurs;

4. Third exercise. Massage your eyebrows with your index fingers. You need to start with light strokes and gradually move on to more intense and faster movements.

Almost all cases of upper eyelid ptosis are reversible. The main thing is to accurately follow all the doctor's recommendations and be patient. Non-surgical treatment for ptosis takes time.

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

Ptosis of the eyelid as an independent disease does not pose a significant health hazard, but it is a significant aesthetic defect and often creates tangible problems for vision. With a strong violation of innervation, patients often have to raise their chin and eyebrows high in order to open the pupil and see objects.

Now in more detail about what is the upper eyelid PTOSIS, what are its causes and whether correction is possible.

Causes and etiology

There are both congenital and acquired types of the disease. Experts unambiguously recognize bilateral PTOZ as congenital, when the overhang of the upper eyelid is present on both the left and right eyes.

A congenital and acquired type of ailment is possible. No more than 25% of people suffering from the disease are characterized by congenital drooping of the upper eyelid. The reasons are mainly due to genetics. Less commonly, PTOZ 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 PTOZ does not accompany other eye diseases and is caused only by the underdevelopment of the muscles of the upper eyelid, then it is dominant in inheritance. As a rule, in the presence of PTOSIS in one of the parents, the defect is transmitted to the child as a dominant sign.

Less common are cases in which the drooping of the upper eyelid is caused by pathologies optic nerve... For a patient with this picture of the disease, the so-called "astrologer pose" is characteristic - a constantly raised chin or raised eyebrows.

Occasionally, congenital upper eyelid PTOSIS 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 muscles of the jaw, 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 of the eyelid 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. At the same time, 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 can be observed.

It is possible, as a rule, to stop or minimize the manifestations of congenital PTOSIS only by surgery.

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

Neurogenic PTOZ is characterized by the presence of diabetic brain pathologies and tumors that compress the oculomotor nerve. The eyelids may close completely. In case of upper eyelid PTOSIS caused by a pinched oculomotor nerve, treatment is aimed at eliminating the root cause of the disease. In some cases (for example, in the treatment of corneal lesions), specialists artificially cause complete prolapse or significant overhang of the upper eyelid by squeezing the oculomotor nerve surgically.

If significant damage to the tendons has occurred in the tissues of the upper eyelid, the muscles of the upper eyelid lose their tone - this picture of the disease is characteristic of aponeurotic PTOSIS. As a rule, drooping of the eyelids when the tendons are damaged occurs due to trauma and after the ingress of foreign objects.

Almost always, acquired PTOSIS accompanies myasthenia gravis - a disease in which the fibers of the muscles of the body, including the oculomotor, lose their 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 drop. When diagnosing the disease, endorphin is used, after its introduction, the symptoms (including bilateral PTOZ) disappear for a while.

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

Neurogenic PTOSI 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 directed towards general recovery - experts do not recommend doing a cosmetic operation while fighting the consequences of the underlying disease.

Mechanical drooping of the eyelids is typical for tumors, foreign body and tissue scarring due to trauma.

Diagnostics for PTOZ

With the overhanging of the upper eyelid, a specialist must clearly understand the etiology of the disease, diagnosis is reduced to finding the causes. If there is a drooping of the upper eyelid, the reasons may be different. With congenital PTOSIS, the treatment tactics are reduced to minimizing and stopping symptoms, with acquired PTOSIS - to eliminating the primary causes.

First of all, a specialist conducts differential diagnostics, you need to exclude infectious diseases and paresis.

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

During the diagnosis, an ophthalmological examination is necessarily carried out in order to identify possible violations, to check visual acuity and the degree of intraocular pressure.

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

Treatment methods

Treatment of PTOI of the upper eyelid is carried out both conservatively and surgically... What to do in a particular case, only a doctor can tell. Many try to carry out treatment at home without diagnosis and supervision from a specialist.

The conservative method is treatment without surgery. This method is used to restore lost muscle tone and nerve conduction. How to treat such an ailment? The complex of activities includes:

1. Physiotherapy.
2. Muscle and nerve stimulation (using galvanic current)
3. Application of a special plaster 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 rarely end in success, but they are quite effective in treating PTOZA of neurogenic etiology, when the disease is caused by a pinched oculomotor nerve. With blepharophimosis and scars on the tissue of the upper eyelid, only surgical intervention, in other cases, eyelid surgery is prescribed after 6 months conservative treatmentwhich turned out to be ineffective.

Correction of the upper eyelid PTOSIS 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 dropped and has almost lost its mobility, the surgeon tries to heal and raise it, suturing it from above (to the forehead muscle). This method of treatment is not very effective, but practically free of complications. Sometimes this surgery is performed on children (when the eyelid drops) as an intermediate step to reduce the risk of visual impairment.

In the case when the overhanging eyelids are mobile, the surgeon resorts to muscle resection. Through a small incision, the doctor removes a small area of \u200b\u200bskin and trims the muscle that lifts it. A decrease in the volume of muscle tissue prevents the eyelid from dropping spontaneously.

In most cases, the postoperative recovery is quick enough and without complications - the stitches are removed as early as 3-5 days after the operation.

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

Home and traditional techniques

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

In order to increase the therapeutic effect when treating 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, applied to the skin of the eyelid for 20 minutes.
2. Finely grated and chilled potatoes are applied for 15–20 minutes. According to practitioners, the colder the more effective.
3. Grated thyme and chamomile are applied to the eye for 15–20 minutes. Indeed, a 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 efficient 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. Start with a warm-up: you need to open your eyes as wide as possible, in a circular motion examine the space around you and squint. Repeat 5-6 times.
2. Keep eyes as open as possible for 10 seconds. Close your eyes tightly for 10 seconds. Repeat 5-6 times
3. As a second exercise, the brows are brought to the bridge of the nose with the index fingers and repeated until the muscles ache.
4. The final exercise - stroke the brow 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, as a result of the muscles of the drooping eyelid.

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

The procedure is carried out in 4 stages:

1. Preparatory. Wash your hands and skin around your eyes thoroughly. Make sure there is no irritation or redness before starting the massage. Apply a moisturizer to clean skin before starting
2. Elementary. The skin around the eyes is stroked with index fingers, they pass along the eyebrow without touching the eyelid. After doing a few circles, you need to blink a little.
3. The main one - with the index finger, alternately rub the eyebrows 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 a decoction of chamomile are used to relieve swelling. It is not recommended to apply ice before or immediately after the massage, it reduces the effectiveness of the procedures.

Conclusion

Even self-treatment had a therapeutic effect, professional diagnostics, consultation and control of an ophthalmologist are required 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 a specific specialist. Do not save on time and money - a properly performed operation will forever eliminate the need for repeated surgical interventions.