Ptosis and bleph

Ptosis, or palpebral ptosis or blepharoptosis, is the fall of the upper eyelid, that is to say the edge of the upper eyelid where the eyelashes are located is lower than normal. Ptosis can be symmetrical or asymmetrical. It can be minimal, moderate or severe, hiding the pupil thus hindering its mink. Minimal ptosis is not always known to the patient and those around him.

Aesthetically ptosis can cause the patient to appear tired, sad, drowsy. The eyebrow, and the eyelid folds are often raised to compensate for the drop of the eyelid.

On the forehead we can see very pronounced wrinkles testifying to a greater activity of the frontal muscle on the side of the ptosis to lift the drooping eyelids and compensate for its fall. This is most noticeable when the ptosis is unilateral with more pronounced wrinkles.

Children with severe asymmetric ptosis can develop amblyopic (lazy eye) with permanent loss of vision. Hence the interest in treating these patients as quickly as possible.

Ptosis can be congenital (present from birth) or acquired.

Congenital ptosis can be unilateral or bilateral, its treatment depends on its severity and the age of the child

The main cause of acquired ptosis is senile involutional ptosis du au vieillissement du tendon du muscle releveur de la paupière supérieure qui permet de soulever la paupière (ce muscle soulève la paupière des milliers de fois par jour pendant toute la vie, son tendon peut se détacher avec le temps).

Other causes like neurogenic ptosis (weakness of the levator of the eyelid resulting from an interruption of nerve control) is due to damage to the oculomotor nerve or Claude Bernard-Horner syndrome. Also myogenic ptosis results from an abnormality of neuromuscular transmission such as in myasthenia gravis, myopathic disease, myotonic dystrophy and ocular myopathies. Finally, there is acquired ptosis ofmechanical origin, observed in case of tumor, or trauma.

False ptosis or pseudo ptosis is very important to find and know.

Dermatochalasis (a large excess of the skin) can be mistaken for ptosis, which can mislead the patient. Hence the interest of a careful examination to assess the levator muscle of the upper eyelid and the position of the palpebral free edge. It is enough to operate the dermatochlasis with an upper blepharoplasty to have a good result and no longer have the effect of a drooping eyelid or pseudo ptosis.

The treatment of ptosis is mainly surgical.

The techniques vary and this depends on the cause of the ptosis, its severity, the function of the levator muscle of the upper eyelid and the age of the patient.

The surgical approach can be anterior through the skin at the level of the palpebral fold which will hide the scar. It consists in tightening and reattaching the levator muscle of the upper eyelid, sometimes resection and reinsertion of the muscle is performed depending on the type, severity and strength of the levator muscle.

In cases where ptosis is minimal, a posterior approach with an incision of the eyelid in the part in contact with the eye (conjunctiva). It is a resection of the conjunctiva and the Müllerian muscle. This technique without apparent skin scar can treat ptosis ranging from to 3 mm with an excellent aesthetic result respecting the palpebral contour.

In cases where the ptosis is severe (called major or total) which are congenital in the vast majority of cases. We do what is called frontal suspension. It is used as a belt to lift the eyelid and secure it over the frontal muscle which continues to contract and moves the upper eyelid. We use the Lata fascia (the tissue that covers the striated muscle) taken from the thigh, or biomaterials like silicone, nylon or others.

Pour les adultes et dans la grande majorité des cas la chirurgie se réalise sous anesthésie locale et en ambulatoire. Pour les enfants c’est toujours l’anesthésie générale.

Before a patient who consults for cosmetic eye surgery, blepharoplasty, or other aesthetic medical or surgical procedures, a careful examination is required to assess the eyelids, their positions, the eyelid margin and the palpebral cleft.

Detecting ptosis is very important because it can be corrected at the same time as a dermatochalasis (blepharoplasty) for a better result.

Before performing a botulinum toxin session, be aware of the presence of ptosis which can be accentuated and worsened after the injection.