Symptom >> Otorhinolaryngology >> Ophthalmology

Drooping eyelids

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The drooping of the eyelids, also known as the ptosis of the upper eyelid, means that part or all of the muscle function of lifting the upper eyelid is lost, so that the upper or lower part of the upper eyelid cannot be lifted up. When the eyes are looking straight ahead, the upper eyelid covers more than 2 mm of the upper edge of the cornea. The muscles of the upper jaw are lifted on the diaphragm and Müler's muscle. The upper jaw is supported by the oculomotor nerve. The Müler's muscle is innervated by the cervical sympathetic nerve. When the two muscles are incomplete or lost, they will appear. The eyelids are drooping. The upper sag is lighter and can cover part of the pupil. In severe cases, all the pupils are covered, which not only hinders the appearance, but also affects vision. In order to overcome the visual impairment, the patient often tightens the frontal muscles and wrinkles the eyebrows to raise the position of the upper jaw. In severe cases, you must look up and even use your fingers to raise your upper jaw to see things.

Cause

Cause

Causes of eyelid drooping:

The ptosis can be divided into two categories: congenital and acquired.

Congenital ptosis is caused by dysplasia of the diaphragm or dysplasia of the oculomotor nucleus. It is born after birth, mostly bilateral, often with genetic factors. If the ptosis caused by the diaphragmatic defect is usually caused by simple ptosis, if it is caused by hypoplasia of the nucleus, there are often other eye abnormalities, such as internal ecdysis. Small splitting, strabismus, etc.

Acquired ptosis can be divided into the following categories according to its etiology:

(1) oculomotor palsy ptosis: caused by damage to the oculomotor nerve or nerve nucleus, usually unilateral, often accompanied by ocular dyskinesia, and sometimes diplopia.

(2) sympathetic paralytic ptosis: part of the symptoms of sympathetic paralysis, more common in neck surgery, trauma and thyroid patients. It is characterized by mild drooping of the upper jaw, slightly higher position of the lower jaw, formation of small cleft palate, retraction of the eyeball, and reduction of the pupil, which constitutes Horner's syndrome.

(3) Myogenic ptosis: common in myasthenia gravis and progressive extraocular muscle paralysis, jaundice caused by myasthenia gravis, the degree of which increases with fatigue, light in the morning, worse in the evening fatigue, injection new After Si Ming, the symptoms improved significantly.

(4) Mechanical ptosis: due to the lesions of the eyelid itself, such as tumor, amyloidosis, severe trachoma, inflammation and edema, trauma, tissue proliferation (like skin disease). In addition to directly destroying the upper iliac crest, it also causes hypertrophy of the eyelid due to the lesion, resulting in mechanical drooping. In addition, there is an unexplained ptosis, that is, senile myopathy, ptosis, caused by primary muscle atrophy, and bilateral, older women are more common.

Examine

an examination

Related inspection

External examination of the eye, ophthalmoscopy, ophthalmoscopy

Eyelid drooping diagnosis:

In order to meet the needs of home treatment methods, it is necessary to adjust and examine the type of ptosis, the cause of the doctor, the degree of sag, the function of the levator, and the relationship between the body and other minute muscles.

1, congenital ptosis, acquired ptosis and general ptosis, and there is often a big difference in the treatment of other treatments. The heart of the mood treatment is more abnormal than the congenital. Therefore, it is necessary to identify a clear plan before the main treatment. First, the prescription should lead the patient to seriously ask about the medical history, family history and age of onset. Children with congenital ptosis often have amblyopia and different visions. The overall upper sag is drooping, and the appearance seems to sag and the function of the diaphragm is present. When the esteemed disease factor is removed, the ptosis disappears. Factors that cause false ptosis:

1 abnormal eyeball: if there is no eyeball, lack of eyeball, eyeball, small eyeball, etc.;

2 eyelid shift: sputum tumor, lacrimal gland tumor, sputum granuloma, elephantiasis, edema, traumatic adhesions and scars;

3 Skin sagging.

4duane withdrawal syndrome.

5horner syndrome;

6 and so on.

2. Measuring the height of the split: the height of the splitting in China is 7.41 to 8.92 mm, and the average measurement of the wolf is 15 mm. Due to age, the height of the colonization is very different from that of the eyeball joints.

3. Lifting the function of the diaphragm: Let the patient's eyes blink forward and look upwards and downwards to measure the height of the splitting, and observe the relationship between the splitting and the eyeball; record the time of the upper lifting to increase the time to judge Upper diaphragm function. In order to avoid the impact of the time when the splitting is large and the frowning muscles, the eyebrows of the doctor should be pressed with two thumbs before the examination and examination, so that only the patient is gazing in all directions, and the height of the splitting is recorded. The captain can't recommend the ascendant to be completely sagging, and the person who can be lightly lifted is not completely drooping. Patients should not be able to look at the pictures in all directions for reference before surgery.

4, if you suspect that myasthenia gravis should be a tensilin test, if the end of the day is drooping and want to buy and the patient is uncomfortable for the elderly, the enthusiasm may have senile sagging and muscle weakness.

5, in the adult surgery for drooping surgery should be invited to the neurology consultation.

Diagnosis

Differential diagnosis

Eyelid sagging confusing symptoms:

Eyelid jump: divided into upper eyelid and lower eyelid jump. In life, many people have experienced eyelid jumping. Bounces often appear in the upper eyelids, sometimes in the lower eyelids, and are not controlled by human thinking and consciousness. Eyelid jump is divided into physiological and psychological, the former generally will soon pass, and sometimes it will last for a few days; while the latter is more serious and progressive development. Pathological eyelid beating can be caused by ametropia (myopia, hyperopia, astigmatism, etc.), intraocular foreign body, trichiasis, conjunctivitis, keratitis, etc., frequent episodes, long duration, large beating range, some people will even eyebrows The forehead, mouth corner and even half of the face are twitching together. In particular, eyelid beating caused by facial muscle spasm, 99% is due to the facial nerves that control the movement of the eyelid muscles are stimulated by abnormal intracranial vascular compression, 1% is caused by intracranial tumors, arachnoid adhesions stimulate facial nerves, and therefore is also regarded as a skull A sign of a disease in the brain.

The ptosis of the upper jaw: due to the insufficiency or loss of the diaphragmatic muscles, or some or all of the upper jaw can not be lifted, the occlusion of some or all of the pupils is called the ptosis. In normal people, the upper margin covers 2 mm of the upper edge of the cornea, and the average width of the split is about 7.5 mm. In order to estimate the function of lifting the diaphragm, the position of the upper eyelid when the eyeball is extremely upward and downward is measured under the premise of offsetting the contraction strength of the frontal muscle. Normal people should be more than 8mm apart. If the difference between the front and the back is less than 4mm, it means that the diaphragmatic function is severely incomplete.

The sacral margin is sagged in the transverse "S" shape: due to the acute sacral lacrimal gland disease, it is characterized by a horizontal "S" shape sag, which is a clinical manifestation of acute sacral lacrimal gland inflammation. Acute axillary lacrimal gland: redness, swelling, pain, tearing discomfort on the lateral side of the upper eyelid, sag in the transverse "S" shape, swelling can spread to the sputum, cheeks, swollen lymph nodes in the ear, tenderness, sputum And solid mass, there is tenderness, no adhesion to the sacral wall and sacral margin, conjunctival congestion and edema on the sacral conjunctiva, lacrimal gland tissue congestion, mucus-like secretions, may be associated with fever, headache, general malaise, if Early appropriate anti-infective treatment, more than 1 to 2 weeks of inflammation subsided, and some sub-acute, only 1 to 2 months to resolve, a small amount of suppuration from the upper conjunctiva perforation, pus discharge into the conjunctival sac or temporarily formed fistula, It can heal in 2 to 3 weeks.