Ptózy

Ptózy, commonly known as ptosis, is a condition characterized by drooping or sagging of the upper eyelid(s) and can affect one or both sides. The term also refers to drooping of other structures, but in medical use it most often describes blepharoptosis. Ptózy may be present at birth (congenital) or develop later (acquired) and can impair the visual field if the lid covers part of the pupil; in children it may cause compensatory head posture.

Causes are categorized as neurogenic, myogenic, aponeurotic/involutional, mechanical, or traumatic. Neurogenic ptosis results from nerve or neuromuscular problems, such as oculomotor nerve palsy or Horner syndrome. Myogenic ptosis arises from muscular disease (for example myasthenia gravis). Aponeurotic ptosis is common with aging and detachment or thinning of the levator aponeurosis. Mechanical ptosis occurs with eyelid edema or tissue excess; trauma or prior eyelid surgery can also cause ptózy.

Diagnosis relies on history and examination, including assessment of levator function and the margin reflex distance (MRD1). Pupil reactivity and binocular alignment are checked, and imaging or referral is used when underlying disease is suspected. Tests may include eyelid measurements and, if indicated, MRI or CT to identify associated conditions or causes.

Treatment depends on cause and severity. Mild cases may be observed; non-surgical options include a ptosis crutch in glasses. Definitive management usually involves ptosis repair, such as levator advancement, resection, or frontalis suspension. Treating the underlying condition is essential. Prognosis varies with etiology and age, but many patients achieve functional eyelid elevation.