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The retraction of the century and the backwardness of the century
Last reviewed: 16.10.2021
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Retraction of the upper eyelid (the position of the upper eyelid, in which the white stripe of the sclera is visible between the edge of the eyelid and the limb of the cornea when viewed directly) is due to the hyperactivity of the muscle lifting the (levator) eyelid, the contracture of this muscle, or the hyperactivity of the smooth (Mullerian) muscle.
The lag of the century is the same phenomenon, observed only when the view is moved downward.
The main reasons for the retraction of the century and the backwardness of the century:
I. Supranuclear damage (it is necessary to damage the nuclear complex of the posterior commissure for the appearance of retraction of the eyelids):
- Processes at the level of the mesencephalon can lead to retraction of the eyelids, which is noticeable when viewed directly and when the gaze moves upward (as part of the Parino syndrome).
- Periodic retraction of the eyelids can be observed in the picture of an epileptic fit or be a sign of a tentorial wedge.
- Parkinsonism.
II. Neuromuscular and some somatic diseases (retraction of the eyelid and lag of the eyelid can be observed in the picture of the following diseases):
- Myasthenia gravis
- Family periodic paralysis
- Myotonic syndromes
- Hyperthyroidism (one-sided or bilateral retraction of the eyelids) is the most frequent cause of retraction of the eyelids.
- Coarse dysfunction of the liver (Summerskill symptom of Summerskill ).
III. Other more rare causes of retraction: retraction of the upper eyelid in the picture of congenital trigemino-oculomotor syncopeesis (Marcus-Gunn phenomenon); after aberrant regeneration of the oculomotor nerve; with the irrigation of oculosympathetic fibers (Claude-Bernard syndrome): the denervation hypersensitivity of the smooth muscle of the upper eyelid in a stressful situation is manifested by the transient retraction of the eyelid on the affected side; with prolonged therapy with corticosteroids; operations and other damage to the muscles of the eye. Insufficient braking m. Levator ("spastic eyelids") may have damage to the brain stem; in these patients, the eyes can remain open during sleep.
The lag of the century can also be observed in the following situations:
- progressive supranuclear palsy;
- Guillain-Barre syndrome.
"Plus-minus syndrome" (ipsilateral ptosis and contralateral retraction of the upper eyelid): the result of unilateral damage to the nucleus or root of the third (oculomotor) nerve, involving the nuclei of the posterior commissure or their connections. The most common reason is ONMI.
Retraction of the lower eyelid is an early sign of damage to the facial nerve. Weakness and lethargy of the lower eyelid may be an early sign of myasthenia gravis and myopathy. Retraction of the lower eyelid is possible with exophthalmos, senile changes in the eyelids, after operations on the eyes and in the process causing a reduction in the tissue of the eyelid (dermatitis, tumors, etc.). It can also be congenital.
Inadequate eyelid closure (during sleep, blinking or forced squinting) can sometimes cause a serious complication (keratitis). Its causes (in addition to retraction of the eyelids): exophthalmos or (more often) weakness of the circular eye muscle (myasthenia gravis, chronic progressive external ophthalmoplegia, myotonic dystrophy, facial nerve neuropathy.
Diseases that occur with the involvement of the retina and the central nervous system.
- Pigmented degeneration of the retina in such hereditary diseases as the Kirns-Seir syndrome, abetalipoproteinemia (Bassen-Kornzweig disease), Lawrence-Moon-Bard-Biddle syndrome, Friedreich's ataxia, Cocaine syndrome (hereditary autosomal recessive disease), Refsum disease, Gallervorden-Spatz disease , ceroid lipofuscinosis (cerebro-retinal degeneration).
- Infectious lesions of the nervous system and retina: syphilis, fungal lesions, tuberculosis, cytomegalovirus infection, herpes simplex, herpes zoster, subacute sclerosing panencephalitis, toxoplasmosis, Whipple's disease, HIV infection.
- Inflammatory diseases: sarcoidosis, multiple sclerosis, Behcet's disease, systemic lupus erythematosus, Vogt-Koyanagi-Harada syndrome, inflammatory bowel disease.
- Malignant neoplasms (sarcoma, lymphoma, leukemia, metastatic carcinoma).