Palpebral ptosis: types, symptoms, causes and treatment.

A review of the characteristics of this condition that causes drooping of the upper eyelid.

Palpebral ptosis is a disorder that affects the eye, causing the upper eyelid to droop.It causes a drooping of the upper eyelid, which generates a series of visual and aesthetic problems in the person who suffers from it.

In this article we explain what is palpebral ptosis, how the different types are classified, what are the symptoms associated with this condition and the indicated treatment.

What is palpebral ptosis?

The palpebral ptosis, blepharoptosis or drooping eyelids, is a condition that causes drooping of the upper eyelid.. This situation prevents the person from opening the affected eye, causing tiredness and making vision difficult.

This pathology affects all ages, although in adults it has a higher incidence. When it occurs in children, called infantile palpebral ptosis, can cause amblyopia (also known as lazy eye) and, as a consequence, loss of visual acuity, because the eye does not receive the necessary visual stimulation to develop normal vision.

Under normal conditions and looking straight ahead, the upper eyelid covering the cornea measures approximately 2 mm. Palpebral ptosis can cause partial or complete occlusion of the pupillary area, with the resulting visual deficit.with the visual deficit that this entails.

Classification and types of ptosis

Palpebral ptosis has been classified indistinctly by different authors, according to factors such as the time of the onset of the ptosis.depending on factors such as the time of onset, the cause, the function of the levator Muscle of the upper eyelid or the degree of drooping of the eyelid, among others.

The most common classification groups them into: myogenic, aponeurotic, neurogenic, mechanical and traumatic.

1. Myogenic ptosis

Myogenic congenital ptosis usually appears at birth with a clear inherited a clear hereditary component, specifically of an autosomal dominant type (the disorder can occur if the abnormal gene is (the disorder can occur if the abnormal gene is inherited from only one parent) and is sometimes sex-related.

It can be congenital or acquired. Congenital can be, in turn, simple myogenic, and is the most frequent type in infancy, its home being levator muscle dysgenesis. It manifests from birth and remains stable.. Three out of four are unilateral (in only one eye), and those that are bilateral are usually asymmetric.

2. Aponeurotic ptosis

Aponeurotic ptosis are caused by an alteration of the aponeurosis (the conjunctival membrane that (the conjunctival membrane covering the muscles), either congenital or acquired, by disinsertion, stretching or dehiscence (spontaneous opening) of the levator muscle of the eyelid.

This type of ptosis is the most common and is usually caused by aging of the eyelid tissues, hence it is also called senile ptosis.

3. Neurogenic ptosis

Neurogenic ptosis occurs infrequently. They may be caused by aplasia (underdevelopment) of the nucleus of the third cranial nerve, due to peripheral lesions, peripheral lesions, or peripheral lesions of the third cranial nerve.due to peripheral, nuclear or supranuclear lesions.

Although this type of ptosis usually occurs in isolation, cases have been described in association with other neurological manifestations, such as: ophthalmoplegic migraine, which causes headache on one side of the head or around the eye; Horner syndrome, which causes neurosympathetic paralysis and pupillary alterations; or Marcus-Gunn ptosis, in which ptosis is produced by certain movements of the mouth or jaw.

4. Mechanical ptosis

Mechanical ptosis occurs when there is an increase in palpebral weight or volume. This type of ptosis are eventually complicated by disinsertion of the levator lid, causing aponeurotic ptosis.causing aponeurotic ptosis.

This group of ptosis includes: palpebral edema of different causes; palpebral tumors; orbital tumors; dermatochalasis or excess of skin in the upper eyelid; and cases of conjunctival scarring, in which there is a shortening of the conjunctival sac fundus that tracts the eyelid.

5. Traumatic ptosis

Traumatic ptosis is caused by trauma affecting the aponeurosis, the levator muscle of the upper eyelid or the nerve itself.. This type of ptosis occurs more frequently in individuals over 18 years of age.

Traumatic impacts can be of various kinds, although in most cases they are caused by a penetrating injury to the levator muscle or by laceration or disinsertion of the aponeurosis.

Symptoms

The most obvious clinical sign of palpebral ptosis is a drooping eyelid. Depending on the severity of the eyelid drooping, people with this condition may may experience vision difficulties. Occasionally, patients need to tilt their head back in order to see under the eyelid, or even have to raise their eyebrows repeatedly to try to lift the eyelids.

The degree of eyelid drooping is different from person to person. To really know if someone has this disorder, it is suggested to compare a recent photo of the face with one that is 10 or 20 years old. If there are noticeable differences in the eyelid skin, it is advisable to see a specialist.

Palpebral ptosis may have similarities to dermatochalasis, a group of connective tissue conditions that causes excess skin on the upper eyelid. which causes excess skin on the upper eyelid. This usually occurs as a result of the passage of time, as the skin loses elasticity and becomes thickened, resulting in the appearance of a tired, aged eyelid.

In summary, it can be said that the most common symptoms associated with palpebral ptosis are as follows are the following:

• Lowering of the upper eyelid partially or totally covering the eye.
• Reduction of the visual field depending on the occluded pupillary area.
• Need to tilt the head backwards.
• In some cases, the person needs to lift the eyelid with his own finger.

Treatment

The treatment of ptosis usually requires surgical procedures. The aim of the surgery is to repair the muscle that lifts the eyelid or, in case it does not work and is completely immobile, to use the forehead as an accessory mechanism, so that an anchor point can be found in the muscle located above the eyebrows to take advantage of its mobility.

This type of treatment, called blepharoplasty, is a non-invasive cosmetic procedure performed on the eyelids. performed on the upper eyelids. During the procedure, excess skin and fat is removed from the eyelids so that the patient can regain a normal appearance.

They are relatively quick interventions (between 45 minutes and 1 hour) that are performed under local anesthesia, have a short recovery period and do not require hospitalization.

This procedure is not free of contraindicationsIt is not recommended for people with health problems that may increase the risk of the procedure. It is also not recommended for pregnant women or patients with dry eyes, hypertension, diabetes, scarring problems, active infections or retinal detachment.

Bibliographic references:

• Clauser, L., Tieghi, R. and Galie, M. (2006). Palpebral ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview. Journal of Craniofacial Surgery, 17(2), 246-254.
• Junceda J., Hernández L. (1996) Palpebral Ptosis: Fundamentals and surgical technique. Editorial Allergan
• Ortiz, S., Sánchez, B.F.(2009) Palpebral Ptosis. Annals d'Oftalmología 17 (4) 203-213
• Manual of Diagnosis and Treatment in Ophthalmology. Editorial Ciencias Médicas. Havana, 2009.