PTOSIS of an upper eyelid (ptosis; grech, ptosis falling; synonym: blefaroplegiya, blepharoptosis) — blepharoptosis. Distinguish the inborn and acquired P.
the Inborn ptosis
the Inborn ptosis is caused by an underdevelopment of the Muscle raising an upper eyelid (m. levator palpebrae sup.), or aplasia of a trunk of a third cranial nerve (n. oculomotorius) or its side pair kernels.
Inborn P. can be unilateral and bilateral. Allocate also full (function of the muscle raising an upper eyelid is absent) and partial P. (when its function is partially kept). Insufficiency of the muscle raising an upper eyelid in a nek-swarm of degree is compensated by tension of a frontal muscle.
At the expressed bilateral P. the sleepy look of the patient with existence of folds on a forehead is characteristic, eyebrows are raised, the head is thrown back (fig. 1) back. At children full P. complicates sight and leads to development of an amblyopia (see).
Inborn P. can be manifestation of an outside ophthalmoplegia (see) or a phenomenon of the Hun, to-rogo bonds between centers, innervating the muscle raising an upper eyelid, and masseters are the cornerstone. At the same time the lowered upper eyelid (left is more often) rises during the opening of a mouth or at the movement of a mandible aside, opposite P. (fig. 2).
Also inborn P. can be combined with damage of an upper direct muscle of an eye, epikantusy (see), loss or decrease in sensitivity of a cornea.
The acquired ptosis
the Acquired ptosis develops as a result of defeat of the centers of the third cranial nerve innervating the muscle raising an upper eyelid at hemorrhages, tumors, focal inflammatory processes in a brain, injuries of the muscle raising an upper eyelid, a trunk of a third cranial nerve (see). The ptosis can develop also at defeat of cervical nodes of a sympathetic trunk and its branches which innervate smooth fibers of a muscle of Müller (see. Muscles ). At the same time along with P. the enophthalmos and a miosis can be observed (see. Bernard-Horner syndrome ). The acquired P. often is combined with damage of a lateral muscle of an eye, a diplopia (see), disturbance of sensitivity of a cornea (see), an exophthalmos (see), etc.
When P. is caused not by damage of a muscle or nerve, and caused by mechanical droop of skin of a century at blepharochalasis (see) — senile P. — or a thickening of a century after abscess of a century, at trachoma, tumors a century, etc., it is called a false ptosis.
P.'s Treatment hl. obr. operational. At the acquired P. also carry out treatment of a basic disease. The considerable effect gives topical administration of physiotherapeutic methods: galvanization (see), UVCh-therapies (see), paraffin applications (see. Paraffin therapy ). If within 6 — 9 months the carried-out treatment does not yield satisfactory results, then operational treatment can be recommended, the indication to Krom is development of an amblyopia in children, restriction of work, cosmetic defect. As contraindications to operation serve decrease or lack of sensitivity of a cornea, the expressed paresis of an upper direct muscle of an eye. In these cases recommend points with special handles, otmodelirovanny on curvature of an upper eyelid. These handles enter a skin fold of an upper eyelid and lift it on the dosed height that allows to perform visual work during limited time.
All types of operations for P. can be divided into three groups.
1. The operations strengthening function of the muscle raising an upper eyelid due to excision of its part or by creation of a duplikatura that conducts to a raising of an upper eyelid (fig. 3). To this group also operations of a podshivaniye lateral (outside) and medial (internal) direct muscles of an eye belong to the muscle raising an upper eyelid.
2. Operations at which action of the muscle raising an upper eyelid amplifies at the expense of an upper direct muscle. At these operations action of an upper direct muscle of an eye is transferred to the muscle raising an upper eyelid (there is a synchronous turn of an eyeglobe up, from top to bottom, a raising and lowering of an upper eyelid).
3. Operations. its bonds with the muscle raising an upper eyelid providing a raising of an upper eyelid with a frontal muscle due to education by means of seams and hems.
Forecast after operational treatment favorable.
Bibliography: O. V pear. Operation for a ptosis with use of a kapron transplant, Vestn. oftalm., No. 4, page 39, 1959; Zaykova M. V. Plastic ophthalmosurgery, M., 1980; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 4, page 127, M., 1959; In 1 a s to about-vics L. A new operation for ptosis with shortening of the levator and tarsus, Arch. Ophthal., v. 52, p. 563, 1923.
O. V. Grusha.