Surgical treatment of ptosis, epicanthus
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Ptosis – is a drooping of the upper eyelid with almost complete lack of control over it. By comparison of both eyes one eyelid is visibly lower than the other.
Upper eyelid ptosis is rather often seen both in the adults and in the children. This state can be congenital and acquired. Congenital ptosis occurs because of hypoplasia, a total absence or incorrect insertion of the muscle, raising the upper eyelid.
Acquired upper eyelid ptosis can develop as long as life endures. Its reasons can be different diseases, traumas of eyelids, disorder of innervation of the muscle, that raises the eyelid.
Ideally the margin of the upper eyelid covers the iris of the eye by 1,5 mm approximately, in case of ptosis of the upper eyelid it droops by more than 2 mm. Upper eyelid ptosis is qualified by its intensity:
- 1st degree – upper eyelid covers the upper third of the pupil;
- 2nd degree – upper eyelid covers the upper two thirds of the pupil;
- 3rd degree – upper eyelid completely covers the pupil.
At high degrees of ptosis the vision in the affected eye can gradually decrement to complete blindness. Strabismus or amblyopia are rather often seen with ptosis. Children usually try to compensate the upper eyelid ptosis by toughening the muscles of the forehead or tilting their heads backwards.
Usually, upper eyelid ptosis does not heal on its own and practically always requires operative intervention. Surgical treatment of ptosis consists in strengthening or tightening of the muscle, raising the upper eyelid. If this muscle is very weakened, the surgeon will need to lift the eyelid and the eyebrow. Operation is performed by the ophthalmosurgeon under local anaesthesia for adults and under general - for children. Surgical treatment of ptosis lasts from half an hour to one hour. After intervention no traces are left and in a week the patient can return to his/her usual life. The effect of the operation will retain forever.
Unfortunately, surgical treatment of ptosis not always produces the desired cosmetic results. After operation eyelids can be asymmetrical.
Epicanthus or «Mongolian fold» — is the most frequently met abnormal development of eyelid. Epicanthus represents a specific vertical fold of skin of semilunar form at the eye interior angle to a greater or lesser extent covering the lachrymal tubercle. The fold, as a rule, stretches from the upper to the lower eyelid and has different sizes, from slight to strongly marked. Epicanthus is mostly bilateral. Prominent epicanthus can limit the field of vision. Epicanthus is a distinctive feature for the Mongoloid and some groups of the Negroid-Australian race. The existence of this fold in representatives of other races is rare and is considered a congenital anomaly.
Congenital epicanthus in children, as a rule, occurs on both eyes and can be located either on the upper or on the lower eyelid. Epicanthus in children is often combined with ptosis, adhesion of eyelid margins, sometimes with strabismus. As a child grows up epicanthus can decrease and even disappear.
The acquired epicanthus also occurs, appearing as a result of cicatrical changes of eyelids, in other words posttraumatic epicanthus.
Epicanthus is removed surgically, which is made mainly for the cosmetic purpose. Epicanthus removal is achieved by means of dissection and displacement of two Z- or delta-shaped skin flaps. In cases when epicanthus is combined with ptosis and blepharospasm, it cannot be removed completely. Removal of posttraumatic epicanthus is performed by excision of the scar tissue and free grafting of the skin flap.