Congenital lowering of the upper part that closes the eye must always be carefully examined. There is a risk of repercussions on visual function
Almost one in a thousand children already have a lowering of the upper eyelid at birth. This condition, said congenital ptosis, it can have various causes and sometimes repercussions on visual function. This is why it is always good not to underestimate it, as he points out Paolo Nucci, full professor of ophthalmology at the University of Milan: “When we talk about ptosis in the pediatric age, we must quickly make a differential diagnosis between forms of a neurological nature, possible alterations of the primary function of the levator muscle of the eyelid or forms in which the eyelid is lower because there is an abnormal growth of tissue and this family includes angiomas and neurofibromas “.
How do you know if ptosis hinders the visual axis?
“Understanding whether the drooping of the eyelid hinders the visual axis is fundamental to establishing the need for surgery. The corneal light reflex test it is very useful for this purpose. In practice, a light is pointed in the child’s eyes: in case of obstruction of the visual axis it is noted that, if one of the two lights normally forms on the cornea in the healthy eye, in the other eye this light does not appear in the corneal reflex. But there are also other signs to evaluate, for example if there is an eyelid alteration linked to a muscle structure that is not so homogeneous (idiopathic ptosis), it is noted that when the baby looks downstrangely, the two eyelids equalize their symmetry, the two eyes appear normal, while when the gaze turns upwards one eye struggles to go up. This is an element of benignity, indicating that the problem is confined only to the levator palpebrae. In neurological forms, on the other hand, which are often linked to a lack of development of the III cranial nerve, it is crucial to establish whether the defective innervation affects only the levator palpebrae muscle or whether other eye muscles are also involved. This is because the III cranial nerve innervates many muscles of the eye for which we generally have a ptosis associated with an eye moved downwards and outwards, a sign that it is a most important and involving nerve palsy“.
Why can ptosis be dangerous and when is surgery needed?
“When the visual axis is busy, ptosis can lead to amblyopia: the visual message does not reach that eye because it is closed or partially closed and therefore develops the “lazy eye”. This is why it must be recognized and treated early, bearing in mind that when the baby is lying in the pram or in the arms of the mother however it looks down and in that position develops vision. So the surgical approach is not so urgent. The ideal is to operate around 18 months, even if the propensity varies from case to case and often from surgeon to surgeon. If the eye is totally closed, surgery is needed right away, already in the first weeks of life. One aspect that should not be overlooked, and which signals a strong indication, is the need that the child shows to lift the chin to be able to overcome the discomfort of ptosis. In these cases, the ophthalmologist evaluates whether surgery is appropriate before the baby starts crawling and walking. While waiting for the operation it is sometimes necessary to bandage the healthy eye to favor the development of vision in the other eye ». The most practiced intervention is that of suspension of the eyelid to the frontal muscle by means of a silicone thread or, sometimes, a portion of tissue taken from the patient himself (fascia lata of the thigh). The operation consists in suspending the eyelid muscle to the frontal one in such a way that the wrinkling of the forehead allows the indirect lifting of the eyelid.
Can it also occur in adults?
The lowering of the eyelid in the adult it is usually a cosmetic problem. “If surgery is used to solve it, the ideal is intervene under local anesthesia to have the patient’s collaboration and thus obtain better results – Nucci points out -. Less often, the drooping of the eyelids can be a consequence of a congenital ptosis of minor entity that drags on from birth and continues to give an aesthetic and psychological problem. Even in adults, ptosis can be acquired and neurogenic in nature, as in myasthenia, with some possibility of pharmacological management or the result of a recent and sudden palsy of the III cranial nerve and in this case it can be managed with a suspension of the eyelid to the frontal muscle “.
October 8, 2021 (change October 9, 2021 | 19:51)
© REPRODUCTION RESERVED
Congenital lowering of the upper part that closes the eye must always be carefully examined. There is a risk of repercussions on visual function
Almost one in a thousand children already have a lowering of the upper eyelid at birth. This condition, said congenital ptosis, it can have various causes and sometimes repercussions on visual function. This is why it is always good not to underestimate it, as he points out Paolo Nucci, full professor of ophthalmology at the University of Milan: “When we talk about ptosis in the pediatric age, we must quickly make a differential diagnosis between forms of a neurological nature, possible alterations of the primary function of the levator muscle of the eyelid or forms in which the eyelid is lower because there is an abnormal growth of tissue and this family includes angiomas and neurofibromas “.
How do you know if ptosis hinders the visual axis?
“Understanding whether the drooping of the eyelid hinders the visual axis is fundamental to establishing the need for surgery. The corneal light reflex test it is very useful for this purpose. In practice, a light is pointed in the child’s eyes: in case of obstruction of the visual axis it is noted that, if one of the two lights normally forms on the cornea in the healthy eye, in the other eye this light does not appear in the corneal reflex. But there are also other signs to evaluate, for example if there is an eyelid alteration linked to a muscle structure that is not so homogeneous (idiopathic ptosis), it is noted that when the baby looks downstrangely, the two eyelids equalize their symmetry, the two eyes appear normal, while when the gaze turns upwards one eye struggles to go up. This is an element of benignity, indicating that the problem is confined only to the levator palpebrae. In neurological forms, on the other hand, which are often linked to a lack of development of the III cranial nerve, it is crucial to establish whether the defective innervation affects only the levator palpebrae muscle or whether other eye muscles are also involved. This is because the III cranial nerve innervates many muscles of the eye for which we generally have a ptosis associated with an eye moved downwards and outwards, a sign that it is a most important and involving nerve palsy“.
Why can ptosis be dangerous and when is surgery needed?
“When the visual axis is busy, ptosis can lead to amblyopia: the visual message does not reach that eye because it is closed or partially closed and therefore develops the “lazy eye”. This is why it must be recognized and treated early, bearing in mind that when the baby is lying in the pram or in the arms of the mother however it looks down and in that position develops vision. So the surgical approach is not so urgent. The ideal is to operate around 18 months, even if the propensity varies from case to case and often from surgeon to surgeon. If the eye is totally closed, surgery is needed right away, already in the first weeks of life. One aspect that should not be overlooked, and which signals a strong indication, is the need that the child shows to lift the chin to be able to overcome the discomfort of ptosis. In these cases, the ophthalmologist evaluates whether surgery is appropriate before the baby starts crawling and walking. While waiting for the operation it is sometimes necessary to bandage the healthy eye to favor the development of vision in the other eye ». The most practiced intervention is that of suspension of the eyelid to the frontal muscle by means of a silicone thread or, sometimes, a portion of tissue taken from the patient himself (fascia lata of the thigh). The operation consists in suspending the eyelid muscle to the frontal one in such a way that the wrinkling of the forehead allows the indirect lifting of the eyelid.
Can it also occur in adults?
The lowering of the eyelid in the adult it is usually a cosmetic problem. “If surgery is used to solve it, the ideal is intervene under local anesthesia to have the patient’s collaboration and thus obtain better results – Nucci points out -. Less often, the drooping of the eyelids can be a consequence of a congenital ptosis of minor entity that drags on from birth and continues to give an aesthetic and psychological problem. Even in adults, ptosis can be acquired and neurogenic in nature, as in myasthenia, with some possibility of pharmacological management or the result of a recent and sudden palsy of the III cranial nerve and in this case it can be managed with a suspension of the eyelid to the frontal muscle “.
October 8, 2021 (change October 9, 2021 | 19:51)
© REPRODUCTION RESERVED
Congenital lowering of the upper part that closes the eye must always be carefully examined. There is a risk of repercussions on visual function
Almost one in a thousand children already have a lowering of the upper eyelid at birth. This condition, said congenital ptosis, it can have various causes and sometimes repercussions on visual function. This is why it is always good not to underestimate it, as he points out Paolo Nucci, full professor of ophthalmology at the University of Milan: “When we talk about ptosis in the pediatric age, we must quickly make a differential diagnosis between forms of a neurological nature, possible alterations of the primary function of the levator muscle of the eyelid or forms in which the eyelid is lower because there is an abnormal growth of tissue and this family includes angiomas and neurofibromas “.
How do you know if ptosis hinders the visual axis?
“Understanding whether the drooping of the eyelid hinders the visual axis is fundamental to establishing the need for surgery. The corneal light reflex test it is very useful for this purpose. In practice, a light is pointed in the child’s eyes: in case of obstruction of the visual axis it is noted that, if one of the two lights normally forms on the cornea in the healthy eye, in the other eye this light does not appear in the corneal reflex. But there are also other signs to evaluate, for example if there is an eyelid alteration linked to a muscle structure that is not so homogeneous (idiopathic ptosis), it is noted that when the baby looks downstrangely, the two eyelids equalize their symmetry, the two eyes appear normal, while when the gaze turns upwards one eye struggles to go up. This is an element of benignity, indicating that the problem is confined only to the levator palpebrae. In neurological forms, on the other hand, which are often linked to a lack of development of the III cranial nerve, it is crucial to establish whether the defective innervation affects only the levator palpebrae muscle or whether other eye muscles are also involved. This is because the III cranial nerve innervates many muscles of the eye for which we generally have a ptosis associated with an eye moved downwards and outwards, a sign that it is a most important and involving nerve palsy“.
Why can ptosis be dangerous and when is surgery needed?
“When the visual axis is busy, ptosis can lead to amblyopia: the visual message does not reach that eye because it is closed or partially closed and therefore develops the “lazy eye”. This is why it must be recognized and treated early, bearing in mind that when the baby is lying in the pram or in the arms of the mother however it looks down and in that position develops vision. So the surgical approach is not so urgent. The ideal is to operate around 18 months, even if the propensity varies from case to case and often from surgeon to surgeon. If the eye is totally closed, surgery is needed right away, already in the first weeks of life. One aspect that should not be overlooked, and which signals a strong indication, is the need that the child shows to lift the chin to be able to overcome the discomfort of ptosis. In these cases, the ophthalmologist evaluates whether surgery is appropriate before the baby starts crawling and walking. While waiting for the operation it is sometimes necessary to bandage the healthy eye to favor the development of vision in the other eye ». The most practiced intervention is that of suspension of the eyelid to the frontal muscle by means of a silicone thread or, sometimes, a portion of tissue taken from the patient himself (fascia lata of the thigh). The operation consists in suspending the eyelid muscle to the frontal one in such a way that the wrinkling of the forehead allows the indirect lifting of the eyelid.
Can it also occur in adults?
The lowering of the eyelid in the adult it is usually a cosmetic problem. “If surgery is used to solve it, the ideal is intervene under local anesthesia to have the patient’s collaboration and thus obtain better results – Nucci points out -. Less often, the drooping of the eyelids can be a consequence of a congenital ptosis of minor entity that drags on from birth and continues to give an aesthetic and psychological problem. Even in adults, ptosis can be acquired and neurogenic in nature, as in myasthenia, with some possibility of pharmacological management or the result of a recent and sudden palsy of the III cranial nerve and in this case it can be managed with a suspension of the eyelid to the frontal muscle “.
October 8, 2021 (change October 9, 2021 | 19:51)
© REPRODUCTION RESERVED
Congenital lowering of the upper part that closes the eye must always be carefully examined. There is a risk of repercussions on visual function
Almost one in a thousand children already have a lowering of the upper eyelid at birth. This condition, said congenital ptosis, it can have various causes and sometimes repercussions on visual function. This is why it is always good not to underestimate it, as he points out Paolo Nucci, full professor of ophthalmology at the University of Milan: “When we talk about ptosis in the pediatric age, we must quickly make a differential diagnosis between forms of a neurological nature, possible alterations of the primary function of the levator muscle of the eyelid or forms in which the eyelid is lower because there is an abnormal growth of tissue and this family includes angiomas and neurofibromas “.
How do you know if ptosis hinders the visual axis?
“Understanding whether the drooping of the eyelid hinders the visual axis is fundamental to establishing the need for surgery. The corneal light reflex test it is very useful for this purpose. In practice, a light is pointed in the child’s eyes: in case of obstruction of the visual axis it is noted that, if one of the two lights normally forms on the cornea in the healthy eye, in the other eye this light does not appear in the corneal reflex. But there are also other signs to evaluate, for example if there is an eyelid alteration linked to a muscle structure that is not so homogeneous (idiopathic ptosis), it is noted that when the baby looks downstrangely, the two eyelids equalize their symmetry, the two eyes appear normal, while when the gaze turns upwards one eye struggles to go up. This is an element of benignity, indicating that the problem is confined only to the levator palpebrae. In neurological forms, on the other hand, which are often linked to a lack of development of the III cranial nerve, it is crucial to establish whether the defective innervation affects only the levator palpebrae muscle or whether other eye muscles are also involved. This is because the III cranial nerve innervates many muscles of the eye for which we generally have a ptosis associated with an eye moved downwards and outwards, a sign that it is a most important and involving nerve palsy“.
Why can ptosis be dangerous and when is surgery needed?
“When the visual axis is busy, ptosis can lead to amblyopia: the visual message does not reach that eye because it is closed or partially closed and therefore develops the “lazy eye”. This is why it must be recognized and treated early, bearing in mind that when the baby is lying in the pram or in the arms of the mother however it looks down and in that position develops vision. So the surgical approach is not so urgent. The ideal is to operate around 18 months, even if the propensity varies from case to case and often from surgeon to surgeon. If the eye is totally closed, surgery is needed right away, already in the first weeks of life. One aspect that should not be overlooked, and which signals a strong indication, is the need that the child shows to lift the chin to be able to overcome the discomfort of ptosis. In these cases, the ophthalmologist evaluates whether surgery is appropriate before the baby starts crawling and walking. While waiting for the operation it is sometimes necessary to bandage the healthy eye to favor the development of vision in the other eye ». The most practiced intervention is that of suspension of the eyelid to the frontal muscle by means of a silicone thread or, sometimes, a portion of tissue taken from the patient himself (fascia lata of the thigh). The operation consists in suspending the eyelid muscle to the frontal one in such a way that the wrinkling of the forehead allows the indirect lifting of the eyelid.
Can it also occur in adults?
The lowering of the eyelid in the adult it is usually a cosmetic problem. “If surgery is used to solve it, the ideal is intervene under local anesthesia to have the patient’s collaboration and thus obtain better results – Nucci points out -. Less often, the drooping of the eyelids can be a consequence of a congenital ptosis of minor entity that drags on from birth and continues to give an aesthetic and psychological problem. Even in adults, ptosis can be acquired and neurogenic in nature, as in myasthenia, with some possibility of pharmacological management or the result of a recent and sudden palsy of the III cranial nerve and in this case it can be managed with a suspension of the eyelid to the frontal muscle “.
October 8, 2021 (change October 9, 2021 | 19:51)
© REPRODUCTION RESERVED