Blepharoptosis can be congenital or acquired, unilateral or bilateral.
The most common causes of acquired drooping eyelid is slackening of the eyelid elevator tendon followed by diseases of the nervous system, muscle diseases or tumors.
The most important eyelid lifter is the levator palpebrae muscle. The superior tarsalis muscle (muller muscle) lifts the eyelid by about two millimeters under stress or slackens when tired.
Blepharoptosis results in narrowing of the palpebral fissure and possibly visual impairment. The eyelid fissure width is usually about nine to 12 millimeters. The upper edge of the eyelid covers the upper border of the iris up to two millimeters. Typically, the distance from the central light reflex on the cornea to the edge of the upper eyelid is two to 4.5 millimeters.
The severity of blepharoptosis is determined by the Levator functional test. The distance of movement of the lid margin from the maximum downward gaze to the maximum upward gaze is measured with eyebrow fixation. If eyelids are still drooping after causal treatment of the underlying disease, surgical correction is possible.
The technique of correction depends on the extent of the dysfunction. In the case of low expression, the eyelid elevator muscle is shortened and fixed back to the edge of the eyelid. If the upper eyelid elevator is very weak, a fascial or tendon sling can be used to suspend the upper eyelid from the frontalis muscle.
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