Symptom >> Otorhinolaryngology >> Ophthalmology

Insufficiency of eyelid closure

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Incomplete closure of the eyelid means that the upper and lower eyelids cannot be completely closed, resulting in partial eyeball exposure, also known as rabbit eye. Mild eyelid closure: due to eyeball reflexive upturn (Bell phenomenon), only the lower bulbar conjunctiva is exposed, causing conjunctival hyperemia, dryness, hypertrophy and hyperkeratosis. Severe eyelid closure: due to corneal exposure, the surface is not wet and dry without tears, leading to exposed keratitis, parenchymal corneal ulcer. And most of the patients' eyelids can not be close to the eye, the puncture can not be in close contact with the tear lake, causing tears.

Cause

Cause

Causes of incomplete closure of the eyelid

1 The most common cause is facial nerve palsy, paralysis of the orbital rim muscle, causing the lower jaw to sagging.

2 followed by scarring valgus.

3 The ratio of eyelid emptyness to eyeball size is imbalanced, such as thyroid-associated eye disease, congenital clearing eye, corneoscleral glaucoma, and eyeball protrusion caused by orbital tumor.

4 Temporary functional eyelid regurgitation may occur during general anesthesia or severe coma. When a few normal people sleep, there is a gap in the cleft palate, but the cornea is not exposed, called the physiological rabbit eye.

Examine

an examination

Eyelid insufficiency examination diagnosis

According to the clinical manifestations of the eye, it can be clearly diagnosed.

Diagnosis

Differential diagnosis

Eyelid closure is confusing

Eyelid relaxation: blepharochalasis syndrome, also known as dermatolysis palpebrarum, atrophic eyelid ptosis (ptosis atrophica), is a rare eyelid disease characterized by recurrent episodes of eyelid edema in adolescents. The skin of the eyelids becomes thinner, the elasticity disappears, the wrinkles increase, and the color changes, which can be accompanied by clinical manifestations such as lacrimal gland prolapse, ptosis and shortening of the cleft palate. In 1807, Beer first described the disease. In 1896, Fuchs called it eyelid retardation. Because the syndrome affects the appearance of the eyelids, it is the main reason for patients to require treatment. The understanding of their clinical manifestations and pathogenesis can help to adopt appropriate methods for treatment.

Eyelid relaxation and upper lip thickening: characterized by loose eyelids and progressive thickening of the upper lip, it is called eyelid relaxation-upper lip hypertrophy syndrome, and some patients have goiter, also known as eye-mouth-thyroid syndrome. From the early onset, the eyelid edema began, after repeated episodes of eyelid skin relaxation, wrinkling, accompanied by telangiectasia, severe eyelid ptosis. From the infants and young children, the lips are repeatedly swollen, and the lips become fibrotic due to inflammation and become thicker into lips. Simple thyroid gland and swelling occur during puberty.

Upper eyelid thickening and relaxation: The head of patients with thick skin periosteal disease is a retrograde cranium, especially the upper eyelids are thick and slack, the ears and lips are also thick, especially large, and the skin of the hands and feet is also hypertrophic. The bones of the extremities and the phalanx are hypertrophied, the fingers and toes are sick, and the sacs and knee joints are effusion. The patient has pain in his limbs and his movements are awkward.

Eyelid drooping: also known as "hanging down." Due to insufficiency or disappearance of the levator palpebral function, or some or all of the upper jaw can not be lifted, the upper jaw is in a drooping position. Divided into complete and partial, monocular or binocular, congenital and acquired, true and false. If congenital, check whether: 1 simple ptosis (lifting or disappearing of the diaphragm function); 2 ptosis with upper rectus muscle function weakened; 3 ptosis with other ankle deformities, such as internal hemorrhoids Skin, etc.; 4 ptosis combined with (Marcus-Gunn) mandibular blinking movement phenomenon. If the nature is acquired, check whether: 1 traumatic eyelid or craniocerebral injury, or cervical sympathetic nerve injury; 2 disease such as myasthenia gravis; 3 mechanical such as trachoma sacral infiltration, or loss of support force of eyelids, If there is no eyeball. When there is suspected myasthenia gravis, it can be used as a test for neostigmine. When it is suspected of sympathetic drooping, it can be used as a test for hydroxyamphetamine.