Ptosis

ptosis
Ptosis: top - sided; at the bottom - bilateral.

Ptosis is ptosis of the upper eyelid. Can be one - way (Fig.), congenital and acquired, complete and incomplete. Congenital ptosis is caused by underdevelopment or absence of muscles, raising the upper eyelid. When complete bilateral ptosis observed sleepy face, raised eyebrows, and head thrown back. Treatment of surgery (plastic surgery).
Acquired ptosis is more often one-sided, develops due to various common diseases, leading to paresis or paralysis of the muscles that raise the upper eyelid. You must treat the underlying disease, physical therapy; in cases of absence of the effect of long-term care shown operation.

Ptosis (from the Greek. ptosis - drop; synonym blepharoptosia) - ptosis of the upper eyelid.
Ptosis can be congenital or acquired (Fig. 1). Congenital ptosis often inherited, almost always bilateral and depends on the insufficient or complete lack of levator muscles, raising the upper eyelid. Acquired ptosis often one-sided and depends on paralysis of levator, innerved oculomotor and sympathetic nerves. This form may be the result of acute and sub-acute diseases of the nervous system, such as heavy infants and injuries. The degree of prolapse century can vary from minor to pronounced when the lid closes completely eye and eye slit missing. Attempts patient to lift the lid by reducing the frontal muscle ineffective and lead to the appearance of folds of the skin of the forehead and high standing eyebrows.
Treatment of congenital ptosis surgery. Surgery for acquired ptosis shown in cases where long-term (six months or more) conservative treatment does not eliminate it. To resolve ptosis asked a lot of operations that are divided into three groups.

ptosis surgery
Fig. 2. Operation Hess (1 - 2 - step).

Fig. 3. The operation of Blascovich (1-4 - operation stages).

Of operations of the first group, when levator transferred to the frontal muscle, most commonly used operation Hess, which is shown in the paralysis of Elevator and upper direct muscles, but with a good function of the frontal muscles. Equipment operation Hess (Fig. 2): skin incision in the middle eyebrows in its entire length. Skin usepreview almost to the ciliary edge of the eyelid. Then impose three mattress suture. Seams are performed so that the loop seams were lying along the line of future skin folds century; the needle is injected at a distance of 2 - 3 mm from each other, spend them and subcutaneously through the thick frontal muscle put on 1-2 cm above the eyebrows. Eyelid lift sutures so that the eye slit a little and not be constrained; seams tied in a bow on the gauze rolls, so that they could be easily unleash and, if necessary, loosen the seam or tighten it. Seams leave for three weeks. For skin wound eyebrows impose knotted seams or subcutaneous seam. This operation has formed subcutaneous connective tissue fibers that while reducing the frontal muscles lift the lid.
In the basis of transactions of the second group lies method proposed Approach (I.e. Motais)resulted in strengthening of the actions of levator through the upper right muscles. Surgery is indicated if ptosis no simultaneous paralysis of the upper direct muscles. This operation is technically difficult and rarely used.
For surgical intervention third group refers operation Averbuch, which form the fold on the tendon Elevator. Widespread its modification - operation of Blascovich (Fig. 3), a technique which consists in the following: eyelid turn on the disc, Eger, velodyne or tweezers of Burchardt - Stropova. Spend a horizontal incision conjunctiva along the top edge of the cartilage. On the upper lip wound impose on the part of the epithelium three mattress suture. Scissors carefully usepreview conjunctiva from Elevator. On this muscle at the place of its attachment impose three supporting seam in the form of loops and put them in one bunch. Tightening the seams, cutting the muscle at the place of its attachment to the cartilage and very carefully usepreview her deep into orbit. The stitches on the conjunctiva, to carry through the muscle proximally from the planned border clipping muscles and a piece of it cut off. Scissors is separated by cartilage from the m. orbicularis and excised it, leaving only a small strip 2-3 mm at the free edge of the century. Three joint imposed on the conjunctiva and the muscle to carry through the cartilage at the upper edge of the rear-to-front and remove the skin just above the edge of the section of the cartilage. The seams are tied on the platen and the ends of them paste strip of adhesive tape to the skin above the eyebrow. Stitches will be removed after 10-14 days.