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      A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options

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          Abstract

          Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.

          摘要

          上睑下垂是视光学和眼科临床中最常见的上睑疾病之一。以上睑下垂为特征的单侧或双侧上睑下垂会影响外观和视觉功能, 这两种情况都会对生活质量产生负面影响。目前已知有几种先天性的上睑下垂, 但获得性上睑下垂 (由各种原因所导致并出现在其后的生活中) 是该病的主要形式。本文就获得性上睑下垂的发病率、病因、鉴别诊断及治疗作一综述。并特别研究获得性上睑下垂的鉴别诊断以及新的治疗方法, 包括手术和药理治疗途径。

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          Most cited references76

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          Severity of visual field loss and health-related quality of life.

          To examine the association between severity of visual field loss (VFL) and self-reported health-related quality of life (HRQOL) in a population-based sample. Population-based cross-sectional study. Participants in the Los Angeles Latino Eye Study (LALES) underwent a comprehensive ophthalmic examination including visual field testing by the Humphrey Automated Field Analyzer II (Swedish Interactive Thresholding Algorithm [SITA] Standard 24-2) [Carl Zeiss Meditec, Dublin, California, USA]. Mean deviation (MD) scores were used to determine severity of VFL both as a continuous variable and stratified by severity: no VFL (MD >or= -2 decibels [dB]), mild VFL (-6 dB < MD < -2 dB), and moderate to severe VFL (MD < -6 dB). HRQOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression analyses and analysis of covariance were used to assess the relationship between HRQOL scores and VFL. Of the 5,213 participants included in this study, 18% had unilateral mild, 1.5% unilateral moderate to severe, 19% bilateral mild, and 6.5% bilateral moderate to severe VFL. Worse NEI-VFQ-25 and SF-12 HRQOL scores were associated with VFL in a linear manner. Four- to 5-dB differences in VFL were associated with a five-point difference in the NEI-VFQ-25 composite and most subscale scores. Persons with VFL had the greatest difficulty with driving activities, dependency, mental health, distance vision, and peripheral vision. HRQOL is diminished even in persons with relatively mild VFL on the basis of MD scores. Prevention and management of persons with VFL may be important in preventing or reducing poor HRQOL related to difficulties in driving, distance and peripheral vision activities, and a sense of dependency.
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            Ptosis: causes, presentation, and management.

            Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1-2 mm), moderate (3-4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or both eyes. Ptosis can be present at birth (congenital) or develop later in life (acquired). Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical or traumatic cause. Usually, ptosis occurs isolated, but may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections. Besides drooping, patients with ptosis complain about tired appearance, blurred vision, and increased tearing. Patients with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows. Continuous activation of the forehead and scalp muscles may additionally cause tension headache and eyestrain. If congenital ptosis is not corrected, amblyopia, leading to permanently poor vision, may develop. Patients with ptosis should be investigated clinically by an ophthalmologist and neurologist, for blood tests, X-rays, and CT/MRI scans of the brain, orbita, and thorax. Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities. Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery. For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed. For moderate ptosis with a levator function of 5-10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed. For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated. Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision. Immediately after surgery, there may be temporary difficulties in completely closing the eye. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation is required.
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              Functional indications for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology.

              To evaluate the functional indications and outcomes for blepharoplasty and blepharoptosis repair by assessing functional preoperative impairment and surgical results.
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                Author and article information

                Contributors
                jbacharach@northbayeye.com
                Journal
                Eye (Lond)
                Eye (Lond)
                Eye
                Nature Publishing Group UK (London )
                0950-222X
                1476-5454
                29 April 2021
                29 April 2021
                September 2021
                : 35
                : 9
                : 2468-2481
                Affiliations
                [1 ]North Bay Eye Associates, Petaluma, CA USA
                [2 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, Bascom Palmer Eye Institute, , University of Miami Miller School of Medicine, ; Miami, FL USA
                [3 ]GRID grid.17635.36, ISNI 0000000419368657, Department of Ophthalmology and Visual Neurosciences, Department of Otolaryngology, , University of Minnesota, ; Minneapolis, MN USA
                [4 ]GRID grid.416498.6, ISNI 0000 0001 0021 3995, Massachusetts College of Pharmacy and Health Sciences, ; Worcester, MA USA
                Author information
                http://orcid.org/0000-0002-7084-4327
                Article
                1547
                10.1038/s41433-021-01547-5
                8376882
                33927356
                1bda4f30-f6fb-45c2-bbe4-5a353715cd61
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 February 2021
                : 15 March 2021
                : 7 April 2021
                Funding
                Funded by: RVL Pharmaceuticals, Inc., an affiliate of Osmotica Pharmaceuticals plc
                Categories
                Review Article
                Custom metadata
                © The Royal College of Ophthalmologists 2021

                Vision sciences
                eyelid diseases,surgery,drug therapy
                Vision sciences
                eyelid diseases, surgery, drug therapy

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