Blepharoptosis: diagnostics and significance of dynamometry for optimizing the treatment of upper lid drooping

Abstract

Ptosis of the upper eyelid remains the most common pathology of the auxiliary apparatus of the eye in children and adults alike. Presently, there are no methods of pharmacological correction for the omission of the upper eyelid; hence, only surgical treatment is available. However, the recommended surgery has been associated with unsatisfactory outcomes in 8–26% of all patients. There are several directions of surgical treatment of blepharoptosis, depending on the main cause of its development and degree, such as operations on the muscle that raises the upper eyelid (levator resection, recession, levatoroplasty with the formation of a duplicate of the levator) and its tendons (aponeurosis); operations on the tarsal plate; and “suspension type” operations. Despite the large number of approaches to surgical treatment available for blepharoptosis they are associated with a high risk of hypo and hyper side effects. Therefore, it is not always possible to eliminate the existing changes or damage in different types of ptosis, which may raise the need for a reoperation, which is quite complicated. The standard linear methods for determining the biometric parameters of the mobility of the upper eyelid and degree of ptosis conducted in the preoperative period do not always result in good outcomes. In fact, no reliable criteria allow the prediction of the outcome of surgical treatment with a high degree of probability and planning the volume of surgery. Therefore, it is extremely likely that the addition of dynamometric analysis of the contractile activity of the upper eyelid lifting and tarsal muscles to the scheme of preoperative diagnosis of blepharoptosis, as well as the continuation and intensification of research aimed at creating the doctrine of the pathomorphology of upper eyelid prolapse in the future, will serve as the key factors contributing to the improvement of the results of surgical treatment of blepharoptosis.

Keywords

blepharoptosis / muscle lifting the upper eyelid / upper tarsal muscle / dynamometry / pathomorphology of blepharoptosis

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