There is talk of ptosis when the upper eyelid margin covers part or all of the pupil. They distinguish various degrees of ptosis, from the lightest to the most severe form, in relation to the degree of coverage of the pupil. This condition is established when the levator muscle of the upper eyelid does not contract properly. The contraction of this muscle may be poor, at various levels, up to be missing entirely.
Each of insufficiency degree of contraction may be present at birth (congenital ptosis) or appear over the years (ptosis acquired). This contrasts with the blefarocalàsi, or more precisely dermatochalasis, due to excess skin that usually occurs with aging and that is resolved with a common upper blepharoplasty.
In ptosis, lower eyelid margin is caused by an impaired functioning of the levator muscle (a muscle that comes from inside the orbital cavity and moves inside of the upper eyelid). This is a voluntary muscle, striated, which has the function of lifting the eyelid. Ptosis is also present in the Marcus Gunn syndrome. In this syndrome, the levator is not innervated, as a rule, by the oculomotor nerve, but, in an unusual way, by the maxillary nerve; this is the reason why the patient raises the eyelid when he opens his mouth. In some congenital ptosis muscle it is even absent and replaced by fibrous tissue. The patient therefore not only presents deficits in the opening of the eyelid, but also in the complete closure. In this case the ‘only technique able to re-suspend the upper eyelid is the’ operation performed by Dr. Grassetti of tarsosospensione to check ligament.
Before surgery, a careful eye examination is necessary to exclude the presence of diplopia: this is a condition in which the two bulbs are not in axis. Ptosis in the patient is accustomed to look with one eye. When the eyelid may rise, after the surgery, the patient will look with both eyes and be sown in this case diplopia. The resulting symptom is headaches. The use of prismatic glasses, or a specific surgical intervention, will correct the diplopia.
The most problematic condition, to operate, is the congenital ptosis. This condition is serious because in the development of the vision, the brain connections between neurons from the retina and the brain cells are successfully only if the baby sees. When the pupil is covered by the eyelid, the small does not see and nerve connections are not formed. If after the first year of life ptosis is still present, it is established a permanent visual defect and therefore it is appropriate to treat it right away.
Therapy and treatment
Ptosis requires surgical correction. In the case of ptosis with decreased functioning of the levator muscle, the surgery involves the ‘shortening of the muscle itself. But when the levator is completely lacking of functionality, reparative surgery Dr. Grassetti is to suspend with microdots suture the tarsus (the rigid part that support the eyelid margin) to check ligament, or at the front extension of the capsule that envelops the eyeball (Tenon’s capsule). The result will persist permanently because not affected by loss of muscle tone or by ‘lengthening of a muscle, but based on the support of a solid structure ligament. The surgery is performed in children with general anesthesia, while in an adult you can perform under local anesthesia, with the assistance of the anesthetist.
The surgery is always successful? Yes, but it may result in overcorrection or ipocorrezione the defect that it is difficult to estimate the operating table because of anesthesia that weakens the muscles of the eyelids, but it is already evident the next morning, when you might need to re-operate immediately, to avoid development of the scars that make it extremely difficult to adjust the level of correction at a later time.