Ptosis in children

Congenital ptosis

1. Dystrophic - simple congenital ptosis:
   • The most common anomaly of the development of the century;
   • is caused by the degeneration of the left upper eyelid;
   • an increase in the latent period of the reaction of the upper eyelid with a gaze downward;
   • degree of smoothness of the fold of the upper eyelid can vary;
   • is accompanied by weakness of the upper rectus muscle;
   • is associated with a syndrome of blepharophimosis.
2. Non-dystrophic origin:
   • the reaction of the upper eyelid to the gaze downward is absent;
   • the function of the left-handed levator is not broken.

Unilateral congenital ptosis

Syndrome of blepharophimosis. Two-sided operated ptosis, telecanthus and blepharophimosis

3. Congenital neurogenic ptosis:
   • usually due to the paresis of the third pair of cranial nerves;
   • distorted regeneration - ptosis can decrease with adduction, gaze down or up;
   • cyclic paresis of the third pair of cranial nerves;
   • paresis of the upper eyelid is characteristic;
   • in the "spastic phase" the eyelid rises, the diameter of the pupil decreases, the eye assumes the position of adduction;
   • periodically there is a "spastic phase", lasting usually less than a minute.
4. 4. The phenomenon of Marcus Gunn - palpebromandibular synkinesia:
   • as a rule, it is combined with ptosis;
   • eyelids rise when the patient opens his mouth, pulls the lower jaw in the opposite direction or swallows;
   • the phenomenon is caused by pterygoid syncopeesis /

[1], [2]

Acquired ptosis

I. Defect of aponeurosis:

1. blepharohalasis;
2. recurrent eyelid edema;
3. acquired aponeurosis defect;
4. well-defined fold of the upper eyelid;
5. often has a two-way character.

II. Neurogenic:

1. paresis of the third pair of cranial nerves;
2. Horner's syndrome:
   • mildly expressed ptosis;
   • elevation of the lower eyelid;
   • miosis;
   • ipsilateral anhidrosis;
3. congenital Horner's syndrome:
   • may be due to birth trauma, as a rule, when using forceps in childbirth;
   • usually has an idiopathic origin;
4. acquired Horner's syndrome - as a rule, is a sign of the defeat of the sympathetic nervous system; often occurs as a consequence of thoracic surgery, including the removal of chest tumors, as well as neuroblastoma, developed in infancy.

III. Myogenic ptosis:

1. myasthenia gravis:
   • in most cases, asymmetric disorder;
   • may have an innate origin if the mother of the child suffers from the same pathology; a transient character is possible;
   • sometimes occurs in infancy;
   • accompanied by hypoplasia and tumors of the thymus;
   • combined with the pathology of the external muscles of the eye, accompanied by doubling;
   • often concomitant weakness of the circular muscle;
   • Diagnostic value has the Tensilon test (Tensilon test) (endophony test);
2. progressive external ophthalmoplegia, usually occurs in older children;
3. mechanical ptosis for tumors of the eyelids, scarring, etc.

External ophthalmoplegia. Two-sided ptosis. The patient opens his eyes by raising his eyebrows

IV. Pseudoptosis:

1. upset movement of the eyeball - the pair eye and its upper eyelid move upwards, and the affected eye and its upper eyelid are not capable of producing a similar movement;
2. blepharochalasis with sluggish, stretched skin of the upper eyelid, which is more often observed in old age or with hemangioma of the upper eyelid.

[3], [4], [5], [6],

Treatment of ptosis

1. Obligatory is a complete examination of the organ of vision, examination of the condition of the eyelids, including their mobility. Determine the position of the eyeball, examine the function of the oculomotor system, clarify the presence of the phenomenon of Bell (Bell).
2. Treatment, as a rule, is surgical. Indication for the operation is a functional or cosmetic defect. With an easy degree of ptosis, an operation is performed using the Fasanella-Servat technique, fixing and excising the upper edge of the cartilage and the lower portion of the muscle of Muller.
3. In congenital moderately expressed ptosis, preference is given to one of the methods of resection of the levator. Cosmetic effect is better when approaching from the conjunctiva, but the front approach is technically simpler and allows resection to take place by a large amount. Complication of extensive resection of the left-hander is a violation of synchronous movements of the eyelids of both eyes with a gaze downward and incomplete closure of the eye gap at night.
4. Surgical intervention with pronounced ptosis usually consists of stitching the muscle using an autogenous broad fascia or synthetic materials.
5. Concomitant strabismus, especially when there is a vertical component, is an indication for surgical correction.
6. The results of the surgical treatment of myogenic ptosis are usually unsatisfactory, the risk of such complication as the unobstruction of the eye gap, especially in cases of the pathological phenomenon of Bell, is increased.

a) Severe unilateral ptosis with no fold of the upper eyelid on the right eye. After the birth, the child was immediately assigned occlusions of the left eye, due to which the visual acuity of the right eye is not reduced, b) The same child after the operation of sewing the leftist on both eyes. In the forehead and eyebrows area, traces on the skin from surgical intervention

Tenson test

It is performed in older children according to the following recommendations. Young children are reduced in proportion to their age.

1. The study is conducted only if it is possible to provide cardiopulmonary rehabilitation.
2. In the presence of ptosis, examine the condition of the upper eyelid, the movements of the eyeball, determine its position.
3. 2 mg of Tenshilon (endrophony hydrochloride) is administered intravenously and pauses for 5 minutes, awaiting the appearance of a possible pathological reaction, reducing ptosis or restoring the movements of the eyeball.
4. After a 5-minute break for 1 to 2 seconds, an additional 8 mg of the drug is additionally administered intravenously.
5. The disappearance of ptosis, restoration of the correct position of the eyeball or normalization of eye movements is regarded as a positive reaction.
6. The side effect in the form of a vascular reaction of parasympathetic origin can be prevented or stopped by intramuscular or intravenous administration of atropine.