Ptosis

Ptosis (edge of the upper eyelid falling)

Ptosis is defined as a fall of the upper eyelid by more or less significant impotence of the levator muscle of the upper eyelid. Several mechanisms can be implicated: neurogenic damage (of nervous origin), myogenic damage (due to a deficit of the muscle), fascial (most often linked to age) or mechanical (after a trauma for example).

The goal of surgical treatment is twofold, both aesthetic and functional (allowing good vision) by lifting the eyelid which alters the upper visual field.

It is most often a traditional 48-hour hospitalization in children, usually reduced to a day hospitalization (ambulatory surgery) in adults.

There is no medical treatment without exception (myasthenic ptosis). Surgical treatment must first take into account the function of the levator muscle of the upper eyelid (quality of the muscle used to raise the eyelid), which partly conditions surgical indications, the techniques of which are varied.

There are essentially three types of intervention: surgery of the levator muscle of the upper eyelid, conjunctivo-Mullerian resection of the deep face of the upper eyelid and suspension of the eyelid to the frontal muscle.

In adults, most often, ptosis has appeared gradually with age and is linked to a disinsertion of the muscular attachment which it suffices to reinsert through a masked incision in the upper palpebral fold. A resection en bloc of the conjunctivo-Mullerian plane located on the deep face of the upper eyelid is sometimes indicated in case of moderate ptosis with satisfactory function of the levator muscle and positivity of the Neosynephrine eye drops test. More rarely, in myopathic ptosis for example, a suspension at the front may be indicated.

The immediate consequences are usually simple, characterized by edema and a possible hematoma resolved spontaneously, accompanied by difficulty closing the eyes. It takes about ten days before resumption of social or school life. Late consequences are generally limited to an inconsequential nocturnal malocclusion, a logical price paid for treatment.