Lee Chia-Chen, Feng I-Jung, Lai Hsin-Ti, Huang Shu-Hung, Kuo Yur-Ren, Lai Chung-Sheng
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Healthcare Administration and Medical Informatics, Chi-Mei Medical Center, Tainan, Taiwan.
Aesthetic Plast Surg. 2019 Aug;43(4):964-972. doi: 10.1007/s00266-019-01344-2. Epub 2019 Mar 14.
Blepharoptosis describes a condition of low-lying upper eyelid that may affect individuals of all ages under various etiologies. It may be of congenital or acquired form by the timing of onset or be divided into myogenic, neurogenic, aponeurotic, or mechanical types according to the mechanism. Our goal was to report the characteristics of age-specific blepharoptosis and to analyze the association between levator function (LF) and ptosis severity of each ptosis subtype.
The retrospective, single-center, cross-sectional study consisted of patients diagnosed with blepharoptosis in the plastic surgery practice at a medical center between September 2009 and May 2017. We reported patients' age at presentation, sex, laterality of ptosis, etiology, classification, and evaluation of ptosis including levator function and ptosis severity.
During a nine-year span of study, a total of 1975 eyelids of 1164 Taiwanese patients aged between 2 and 88 years were enrolled in the research (mean = 57.73 ± 13.41 years). The female-to-male ratio was 2.72 (95% confidence interval [CI]: p < 0.0001). Acquired blepharoptosis and bilateral blepharoptosis were more frequently observed (55.85%, p < 0.0001 and 69.67%, p < 0.0001, respectively). In age-specific relative incidence of blepharoptosis, myogenic ptosis was the majority in patients younger than 40 years. Early onset of aponeurotic ptosis was observed in young contact lenses wearers. Aponeurotic blepharoptosis was the predominant type of ptosis in the senior population older than 40 years (p < 0.0001). Among the subtypes, mechanical ptosis had the most preserved LF (p < 0.0001). LF and MRD1 had statistically positive correlations in all subtypes of blepharoptosis, in which neurogenic ptosis demonstrated the severest levator dysfunction for each millimeter in MRD1 reduction.
Of the 1164 Taiwanese patients, blepharoptosis had a higher propensity for female gender and the age between the second to fourth decades. Bilateral involvement of blepharoptosis with acquired type was frequently diagnosed. Myogenic ptosis had a preponderance in age younger than 40 years, while aponeurotic ptosis usually affects senile population. Many mild degree myogenic ptosis was simultaneously recognized in young-aged adults seeking aesthetic double eyelid surgery. Early onset of acquired aponeurotic ptosis was also observed in contact lens wearers given the trend of decorative contact lens use. Levator dysfunction was implicated in the pathology of not only myogenic ptosis but aponeurotic, mechanical, and neurogenic ptosis. Moreover, levator function of neurogenic ptosis was most severely impacted in each MRD reduction among all subtypes of blepharoptosis.
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上睑下垂是指上睑位置低垂的一种病症，可在各种病因影响下发生于各年龄段人群。根据发病时间，可分为先天性或后天性；根据发病机制，又可分为肌源性、神经源性、腱膜性或机械性。我们的目的是报告不同年龄段上睑下垂的特征，并分析提上睑肌功能（LF）与各上睑下垂亚型的上睑下垂严重程度之间的关联。
这项回顾性、单中心横断面研究纳入了2009年9月至2017年5月间在某医疗中心整形外科确诊为上睑下垂的患者。我们报告了患者就诊时的年龄、性别、上睑下垂的患侧、病因、分类以及对上睑下垂的评估，包括提上睑肌功能和上睑下垂严重程度。
在为期九年的研究期间，共纳入了1164名年龄在2至88岁之间的台湾患者的1975只眼睑（平均年龄=57.73±13.41岁）。女性与男性的比例为2.72（95%置信区间[CI]：p<0.0001）。后天性上睑下垂和双侧上睑下垂更为常见（分别为55.85%，p<0.0001和69.67%，p<0.0001）。在按年龄划分的上睑下垂相对发病率中，肌源性上睑下垂在40岁以下患者中占大多数。在年轻的隐形眼镜佩戴者中观察到腱膜性上睑下垂的早期发病。腱膜性上睑下垂是40岁以上老年人群中主要的上睑下垂类型（p<0.0001）。在各亚型中，机械性上睑下垂的提上睑肌功能保留最多（p<0.0001）。在所有上睑下垂亚型中，提上睑肌功能（LF）与上睑下垂量（MRD1）在统计学上呈正相关，其中神经源性上睑下垂在MRD1每减少一毫米时提上睑肌功能障碍最为严重。
在1164名台湾患者中，上睑下垂在女性以及二三十岁年龄段中更为常见。后天性双侧上睑下垂的诊断更为频繁。肌源性上睑下垂在40岁以下人群中占优势，而腱膜性上睑下垂通常影响老年人群。在寻求美容双眼皮手术的年轻成年人中，同时发现许多轻度肌源性上睑下垂病例。鉴于装饰性隐形眼镜的使用趋势，在隐形眼镜佩戴者中也观察到后天性腱膜性上睑下垂的早期发病。提上睑肌功能障碍不仅与肌源性上睑下垂的病理有关，还与腱膜性、机械性和神经源性上睑下垂有关。此外，在所有上睑下垂亚型中，神经源性上睑下垂在MRD每减少时提上睑肌功能受影响最为严重。
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