公益財団法人田附興風会 医学研究所北野病院

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ptosis

Departments

Medical Departments

ptosis

attending physician Dr. Yoshihisa Suzuki
Outpatient Ptosis Outpatient Clinic (2nd and 4th Thursdays)

Ptosis is a condition in which the upper eyelid (upper eyelid) does not lift sufficiently when you try to open your eyes, obscuring part of the pupil (black part of the eye). The eyelid is made of a cartilage called the tarsal plate, which supports and protects the eyeball, and is attached to a muscle called the levator palpebrae superioris, which lifts the eyelid. Behind the levator palpebrae superioris runs a thin muscle called the Müller's muscle, which works together with the levator palpebrae superioris to open the eyelid. The levator palpebrae superioris forms a very thin membrane called the levator aponeurosis near the tarsal plate. When the levator palpebrae superioris contracts and pulls up the levator aponeurosis, lifting the eyelid along with the tarsal plate and allowing the eye to open. Ptosis occurs when the levator palpebrae superioris becomes loose or detaches from the tarsal plate, preventing the eyelid from lifting properly.

Symptoms

When you have ptosis, you can't lift your eyelids properly, which obscures your pupils and makes it difficult to see. This causes unconscious tension in the forehead muscles, leading to the habit of lifting your eyebrows and lifting your eyelids, which causes wrinkles on the forehead. The skin on your eyelids, between your eyebrows, and at the corners of your eyes also stretches, causing your eyelids to sag and disrupting your double eyelid line. Additionally, the fat in your upper eyelids is pulled back, causing your eyelids to sink. It can also cause headaches and stiff shoulders.
This type of ptosis can be treated with surgery, which can help open your eyes more easily and restore a more youthful appearance to your face.

Left: Normal Right: Ptosis

cause

  • Age-related loosening of the levator palpebrae superioris
  • Long-term contact lens wear
  • Habit of rubbing eyelids (itching due to allergic conjunctivitis, etc.)
  • Nerve paralysis (oculomotor nerve palsy, myasthenia gravis, facial nerve paralysis, etc.)
  • Trauma, etc.

kinds

  • Acquired ptosis

    • Aponeurotic flaccid ptosis
      This condition occurs when the levator aponeurosis of the superior palpebrae superioris becomes loose or separates from the tarsal plate, preventing the force needed to open the eyelid. As the person tries to lift the eyelid using the muscles in the forehead, wrinkles form on the forehead.
    • Skin flaccid ptosis
      This condition occurs when the connection between the levator muscle and the supporting tissues of the eyelid, the tarsal plate and skin, loosens with age, but in most cases the levator muscle function is good.
    • Nerve palsy (such as oculomotor nerve palsy or myasthenia gravis) or traumatic
      The levator function itself may be impaired, and other ocular and systemic complications may occur.

  • congenital ptosis

    This is a condition in which the upper eyelid cannot be lifted sufficiently due to a congenital developmental disorder of the levator palpebrae superioris and Müller's muscle, or an abnormality in the nerves that control muscle movement.
    If the eyelids are able to open to a certain extent, surgery is usually performed after the age of 3 while observing the development of vision. In cases of extremely severe ptosis, there is a risk of developing amblyopia, so surgery may be performed earlier under general anesthesia.
    If congenital ptosis is suspected, it is important to visit an ophthalmologist as soon as possible to have your visual function evaluated and to check for any complications.

treatment

If there is no impairment to the levator function, we perform surgery to remove the excess skin.If the levator muscle is loose or has come off the tarsal plate and the function of the levator muscle is not being transmitted properly to the tarsal plate, we perform levator shortening surgery or levator advancement surgery to reattach the levator muscle and tarsal plate.The skin incision may be made along the double eyelid line or under the eyebrow.
The procedure varies depending on the degree of levator function and symptoms, and if the levator function of the superior palpebra is severely impaired, a frontalis lift is performed. A frontalis lift is a method of moving the eyelids using the power of the forehead muscle (frontalis muscle). An artificial membrane called Gore-Tex or the quadriceps aponeurosis is often used, but thick thread may also be used.

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