Latting Michelle W, Huggins Alison B, Marx Douglas P, Giacometti Joseph N
Wills Eye Hospital, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Division of Oculoplastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas.
Semin Plast Surg. 2017 Feb;31(1):5-16. doi: 10.1055/s-0037-1598188.
Aponeurotic ptosis accounts for the majority of acquired ptosis encountered in clinical practice. Other types of ptosis include traumatic, mechanical, neurogenic, and myogenic. In addition to true ptosis, some patients present with pseudoptosis caused by globe dystopia, globe asymmetry, ocular misalignment, or retraction of the contralateral lid. It is particularly important for the clinician to rule out neurologic causes of ptosis such as dysfunction of the third cranial nerve, Horner's syndrome, and myasthenia gravis, as these conditions can be associated with significant systemic morbidity and mortality. A thorough history and physical examination is necessary to evaluate each patient presenting with a complaint of ptosis. Correctly identifying the cause of the patient's complaint allows the ptosis surgeon to plan for appropriate surgical repair when indicated and to defer surgery when observation or additional clinical evaluation is warranted.
腱膜性上睑下垂占临床实践中获得性上睑下垂的大多数。其他类型的上睑下垂包括外伤性、机械性、神经源性和肌源性。除了真性上睑下垂外，一些患者还表现为假性上睑下垂，这是由眼球异位、眼球不对称、眼位偏斜或对侧眼睑退缩引起的。临床医生排除上睑下垂的神经学原因尤为重要，如第三脑神经功能障碍、霍纳综合征和重症肌无力，因为这些情况可能与严重的全身发病率和死亡率相关。对于每一位主诉上睑下垂的患者，都需要进行全面的病史询问和体格检查。正确识别患者主诉的原因，使上睑下垂手术医生能够在有指征时计划进行适当的手术修复，并在需要观察或进一步临床评估时推迟手术。
