HomeCosmetic problemsOmission of the upper eyelid

Omission of the upper eyelid

02.09.2022

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Omission of the upper eyelid
The omission of the upper eyelid is a condition of the skin of the upper eyelid, in which they hang over the eye socket by 2 or more millimeters, can be localized on one or two eyes.

The content of the article:
Classification of the omission of the upper eyelid
Causes of omission of the upper eyelid
Symptoms of drooping of the upper eyelid
Diagnosis of upper eyelid prolapse
Treatment of upper eyelid prolapse
Prognosis when the upper eyelid is lowered
Omission of the upper eyelid
When the skin is deformed, when the eyelid is lowered, a person’s eyes even in the open state seem closed, which is noticeable without special equipment during visual inspection. Omission of the skin is diagnosed in a large number of people, while various causes can provoke ptosis, which requires patients to contact specialists for help in a timely manner, especially if such a problem is observed in childhood.

Quite often, patients consider the drooping of the upper eyelid not a pathological condition of the skin, but a process of natural aging, the only drawback of which is a decrease in the viewing angle. However, do not underestimate this defect, because even a slight interference with vision can lead to a number of serious violations of human functional abilities. Constant tension of the eyebrows in order to lift the lowered eyelid leads to frequent headaches, and if ptosis is of the last degree, then the patient needs to tilt his head back to view the picture.

Classification of the omission of the upper eyelid
In plastic surgery and ophthalmology, the omission of the upper eyelid is classified according to several main signs and time of appearance. If the patient has this defect from birth, then it is attributed to the congenital condition of the upper eyelid, if there was no omission of the eyelid at birth, and the defect appeared at an older age, then it is classified as acquired.

The degree of omission of the upper eyelid is divided into three stages:

partial overlap — the pupil is hidden for 30-35%;
incomplete overlap — the pupil is hidden by 50%;
full overlap — the pupil is 100% hidden.
Depending on the true cause of the drooping eyelid , the defect may be of the following type:

neurogenic — is the result of disorders of the nervous system and accompanies diseases such as meningitis, multiple sclerosis, stroke and others. It is characterized by a narrowed or dilated condition of the pupil on the one hand, reclining of the eyeball or paralysis;
aponeurogenic — develops as a result of a violation of the retention abilities of the eye muscle, which is responsible for lifting the eyelids. This pathology is often the result of unsuccessful plastic surgery, during which a facelift was performed;
mechanical omission — appears as a result of injury to the eye or eyelid or the presence of a foreign body in the conjunctiva, is often diagnosed in athletes and people working in a certain area of industry (for example, mining, timber processing, etc.);
false omission is a skin condition in which wrinkles on the eyelids are mistaken for omission, there is mainly in people of senile age.
Causes of omission of the upper eyelid
In the case when the omission of the upper eyelid was diagnosed, the causes of this pathology must be determined very precisely: they affect the development of the patient’s treatment plan.

If we consider a birth defect, then most often it is provoked by various kinds of injuries or diseases, as well as surgical interventions. Pathology can also be accompanied by strabismus or amblyopia, facial nerve injury. With congenital pathology, the patient’s development and formation of the functions of the ocular muscle is disrupted, which leads to its thinning and weakness, the defect may be a genetic feature or the result of birth trauma. If you do not pay attention to the drooping of the upper eyelid and take it for a normal position, then in the future the child may develop anisometropia — a disease characterized by different visual acuity in the right and left eye.

In the case of acquired drooping of the upper eyelid, the most common cause is the natural aging of the body, which is accompanied not only by the withering of the skin, but also by a violation of the physiological abilities of a person, which causes atrophy of the elevator muscles responsible for lifting the upper eyelid.

Symptoms of drooping of the upper eyelid
Given the fact that the causes of pathology are very diverse, the symptoms of upper eyelid prolapse also differ and directly depend on etiological factors, however, this did not prevent specialists from identifying a number of main symptoms that are more or less present with the drooping of the upper eyelid in each patient. These include:

deviation from the visual axis of one or both eyes from the joint fixation point, in other words — strabismus;
the feeling of constant drying out of the mucous membrane of the eye, the so-called “sand in the eyes”, which makes a person blink more often;
constant eye strain, leading to rapid fatigue and decreased concentration;
the presence of clearly visible red veins on the eyes;
the upper eyelid is severely restricted in movement;
feeling irritated eyes, the desire to scratch them;
the lack of the possibility of complete closure of the eye with the upper eyelid;
overhanging of the upper eyelid on the eye;
image splitting;
the desire to constantly tilt your head back and up, which allows you to increase the viewing radius;
with a unilateral lesion, the eye significantly loses visual acuity, the deviation of the head to the side where the eyelid creeps over the eye, the absence of a symmetrical size and position of the eye slits;
raising the upper eyelid is accompanied by eyebrow movements.
Doctors note that these symptoms are the main ones, but they may not be diagnosed in full, and in some clinical cases, on the contrary, they may be supplemented by a depression of the eyeball or narrow pupils.

Diagnosis of upper eyelid prolapse
It is not difficult to establish a pathological omission of the upper eyelid. The primary diagnosis is made on the basis of a visual examination by a specialist. It is more difficult to identify the severity of the disease: for this, doctors determine the distance from the central point of the pupil to the marginal line of the upper eyelid. The intersection of the midline of the pupil with the eyelid is the zero reference point, when the eyelid is lowered to the middle of the pupil and above, values with a plus from 1 to 5 are used, when crossing below the pupil, a minus value from 1 to 5 is indicated.

Also, in order to make an accurate diagnosis, the patient must undergo a comprehensive examination, during which the level of visual acuity, its field will be determined, an examination of the fundus with an ophthalmoscope, an examination of the cornea of the eye, an examination of the ocular media and eye tissues with a slit lamp, as well as an analysis of tear fluid will be required.

The key to a high-quality and correct diagnosis is the patient’s condition. During the examination, a person should be in the most relaxed state: try not to strain the frontal area and not to frown, if this is not done, then the results of the examinations may be incorrect. Special attention in the diagnosis of upper eyelid prolapse is paid to children’s patients, which is due to the possibility of concomitant diseases.

Treatment of upper eyelid prolapse
With the diagnosis of “omission of the upper eyelid”, treatment is prescribed only by a doctor after a thorough diagnosis of the patient, and the favorable outcome of therapeutic and surgical procedures directly depends on the stage of the disease and how timely the patient sought help.

The omission of the upper eyelid is treated — mainly by the operative method. Surgical intervention is not performed for children under three years of age, which is associated with the incomplete process of formation of the eye slit and eyelids. As preventive procedures for the development of upper eyelid prolapse, children of this age are pulled up and fixed with a patch in this position (the patch is removed during a night’s sleep).

In those situations where the drooping of the upper eyelid occurs against the background of disorders of the nervous system, therapy is primarily aimed at eliminating neurological disease.

Depending on the nature of the pathology, the doctor will determine the method of surgical intervention. If the pathology is congenital, then as a result of the operation, the specialist will perform shortening of the elevator muscle, which is responsible for the process of lifting the eyelid. During the intervention, a section of the skin of the upper eyelid is removed, then a seam is applied to the muscle, with a pronounced lowering of the upper eyelid, the elevator muscle is sewn to the frontal muscle.

In the case of acquired drooping of the eyelids, not only the skin area is removed, but also part of the aponeurosis of the muscle.

The operation involves the introduction of local anesthesia, is characterized by speed and minimal pain. The sutures are removed 3-5 days after the intervention.

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