Anomalies in the development and position of the eyelids

About 10% of all eye diseases are diverse and numerous lesions of the eyelids. Many of these diseases cause severe disruption of their functions.

The development of the eyelids begins at the end of the second month of intrauterine development of the child. At the same time, skin folds are formed, which grow towards each other. Approximately to the 4th-5th month of pre-natal life, these folds grow together. Shortly before birth, this fusion of the upper and lower eyelids is reversed, leading to the formation of a normal eye gap. Violation of this process leads to various anomalies. Anomalies in the development and position of the eyelids are due to the influence on the child's organism of numerous factors that acted during the period of laying and development of the eyelids. Anomalies of the eyelids can be of a family nature and be inherited.

Ablefary is a complete congenital absence of eyelids and an ocular fissure. The eyelids are replaced by skin, under which you can feel the undeveloped eyeball. This anomaly is more often bilateral, but in the literature there are descriptions of cases of unilateral and partial underdevelopment of the eyeball, eyelids and the eye gap( cryptophthalmus).Operative treatment does not bring the expected effect.

Ankiloblepharon is a congenital fusion of the upper and lower eyelids. This disease is extremely rare. Significantly more ankyloblopharon occurs after ulcers, lesions and burns of the eyelids. The fusion can be complete or partial. In the latter case, between the upper and lower eyelids there are dense scars or thin tensile threads from the skin.

A very rare developmental anomaly is the microfibreon - a significant shortening of the eyelids in a vertical dimension. Thus the person can not completely close eyelids, as a result of which there is incomplete closure of the eye - lagophthalmus.

Congenital defect of the eyelid( coloboma) is observed somewhat more often. Such a defect is usually formed on the upper eyelid, more often in its middle part. Sometimes this pathology can occur on the lower or both eyelids. Koloboma( the defect of the tissue of the century) has the form of a triangle with a base at the edge of the century. Its severity can vary widely: from a small depression along the edge of the century to a significant defect in all its layers. Often, from the top of the colobolics to the eyeball, there are dermal ligaments that severely restrict its movements.

Among the congenital anomalies of the eyelid, the epicanthus is most often seen - a semilunar skin fold on both sides of the dorsum of the nose that covers the inner corner of the eye gap. Epicanthus is often combined with the congenital lowering of the upper eyelid. In this case, a person can not fully open the eye gap on the side of the lesion. Also epicanthus is often combined with strabismus or shortening of the eye gap in the horizontal direction( blepharophimosis), which in most cases is due to the fusion of the edges of the upper and lower eyelids. With a pronounced epicanthus, the inner angle of the eye gap( closer to the nose) closes so much that it limits the field of view. In these cases, surgical treatment is necessary not only for cosmetic reasons, but also for improving visibility.

Blepharophimosis is the shortening of the eye gap in the horizontal direction, usually characterized by the fusion of the edges of the upper and lower eyelid at the outer corner of the eye. As a result of the pressure of the eyelids on the eyeball, blood circulation in the blood vessels of this organ is disturbed, which leads to a deterioration in the nutrition of the cornea of ​​the eye. With such anomalies, surgical treatment is performed.

Blefarohalasis is an overgrowth of the skin of the upper eyelid, in which it assembles into small fine folds and hangs over the edge of the eyelid. This anomaly of development of the organ of vision is eliminated only by carrying out the operation.

Ptosis - descent of the upper eyelid. This anomaly of the condition of the eyelids occurs most often. Congenital ptosis can occur due to the underdevelopment of the muscle that lifts the upper eyelid, or as a result of the defeat of nerves involved in the movement of the eye muscle. If the oculomotor nerve is damaged, the eyelid drooping is accompanied by a restriction of mobility of the eyeball. Less pronounced omission is observed in the defeat of the sympathetic nerve, since it innervates only a part of the muscle that lifts the upper eyelid. Ptosis can be complete or partial, as well as one- or two-sided. When the upper eyelid is lowered, wrinkles appear on the forehead quite early: a man has to tilt his head and wrinkle his forehead.

There are III degrees of ptosis.

I degree( partial ptosis). In this case, the upper eyelid covers the cornea to the upper third of the pupil.

II degree( incomplete ptosis). With this lesion, the cornea is covered up to half the pupil by the eyelid.

III degree( complete ptosis) .In this case, the eyelid covers the entire pupil.

With a significant lowering of the upper eyelid, visual acuity on this side is lowered, and the field of view is somewhat narrowed, as unfavorable conditions for the functioning of the retina occur. Due to the reduction in acuity and field of vision, strabism often develops in this anomaly, for the elimination of which a whole complex of measures is being implemented, including both conservative and surgical treatment. Surgical treatment of the lower eyelid descent is performed not only for cosmetic purposes, but also in order to prevent a decrease in visual acuity in the future.

To prevent the reduction of visual acuity and the development of strabismus during the descent of the upper eyelid, it is necessary to raise the upper eyelid( or both upper eyelids in case of bilateral injury) during wakefulness. Such exercises should be performed within a year after diagnosis. To do this, one end of the strip of adhesive tape is fixed at the edge of the eyelid, and the other is attached to the area of ​​the eyebrow with a raised eyelid. The eyelids are raised so that when blinking, the possibility of their almost complete closure remains. At the time of sleep, the adhesive plaster is removed in order to avoid damage to the skin of the eyelids.

In congenital ptosis, the operation is usually performed at the age of three, since at that time the size and shape of the optic cleft and face have already been determined.