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上睑下垂概述

Author
Michael S Lee, MD
Section Editor
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD
Translators
吴亚明, 副主任医师

引言

眼睑下垂，或上睑下垂指的是通常由先天性或获得性提升眼睑的肌肉异常导致的上眼睑下垂。上睑下垂可能是严重神经系统疾病的主诉体征或症状。无论病因如何，当上睑下垂阻挡视线时其是致失能的。恰当的处理需要识别其基础原因。

解剖学

面神经，即第七颅神经支配眼睛周围的眼轮匝肌闭合上下眼睑。动眼神经，即第三颅神经支配上睑提肌提升上眼睑。上睑提肌变成一种肌腱腱膜，与上睑板前上方部以及可能与睑板前皮肤接合(图 1)。腱膜到睑板和眼轮匝肌的接合处形成重睑线[1]。

另外还有一条辅助平滑肌，Müller肌，受交感神经系统支配。它起始于上睑提肌的底面，并附着于上睑板。它有助于提高上眼睑1-2mm(图 1)[2]。Müller肌在患者变得兴奋或恐惧时促进眼睑过度上抬，而在疲劳或注意力不集中时引起轻度上睑下垂。

标志 — 成人正常的重睑线距离睑缘6-7mm。这种皮褶在大多数亚洲人眼睑中是不明显的[3]。上睑通常遮盖角膜顶部1mm，下睑通常位于角膜和巩膜交界处(图片 1)[4]。

睑裂(palpebral fissure, PF)表示在瞳孔轴线上的上下眼睑边缘之间的距离。正常睑裂高度为9-12mm。

                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-02-25.
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References
Top
  1. Collin JR, Beard C, Wood I. Experimental and clinical data on the insertion of the levator palpebrae superioris muscle. Am J Ophthalmol 1978; 85:792.
  2. Beard C. Müller's superior tarsal muscle: anatomy, physiology, and clinical significance. Ann Plast Surg 1985; 14:324.
  3. Jeong S, Lemke BN, Dortzbach RK, et al. The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid. Arch Ophthalmol 1999; 117:907.
  4. Dortzbach RK, Gausas RA, Sherman D. Blepharoptosis. In: Ophthalmic Plastic Surgery: Prevention and Management of Complications, Raven Press, New York 1993. p.65.
  5. Cartwright MJ, Kurumety UR, Nelson CC, et al. Measurements of upper eyelid and eyebrow dimensions in healthy white individuals. Am J Ophthalmol 1994; 117:231.
  6. Boboridis K, Assi A, Indar A, et al. Repeatability and reproducibility of upper eyelid measurements. Br J Ophthalmol 2001; 85:99.
  7. Toyka KV. Ptosis in myasthenia gravis: extended fatigue and recovery bedside test. Neurology 2006; 67:1524.
  8. Baldwin HC, Manners RM. Congenital blepharoptosis: a literature review of the histology of levator palpebrae superioris muscle. Ophthal Plast Reconstr Surg 2002; 18:301.
  9. BERKE RN, WADSWORTH JA. Histology of levator muscle in congenital and acquired ptosis. AMA Arch Ophthalmol 1955; 53:413.
  10. Johnson CC. Congenital ptosis. In: Principles and Practice of Ophthamology, Jakobiec FA, Albert DM. (Eds), WB Saunders Co, Philadelphia 1994. p.2839.
  11. Ahmadi AJ, Sires BS. Ptosis in infants and children. Int Ophthalmol Clin 2002; 42:15.
  12. Smith B, McCord CD, Baylis H. Surgical treatment of blepharoptosis. Am J Ophthalmol 1969; 68:92.
  13. Anderson RL, Baumgartner SA. Strabismus in ptosis. Arch Ophthalmol 1980; 98:1062.
  14. Sevel D. Ptosis and underaction of the superior rectus muscle. Ophthalmology 1984; 91:1080.
  15. Freedman HL, Kushner BJ. Congenital ocular aberrant innervation--new concepts. J Pediatr Ophthalmol Strabismus 1997; 34:10.
  16. Dortzbach RK, Sutula FC. Involutional blepharoptosis. A histopathological study. Arch Ophthalmol 1980; 98:2045.
  17. Kersten RC, de Conciliis C, Kulwin DR. Acquired ptosis in the young and middle-aged adult population. Ophthalmology 1995; 102:924.
  18. van den Bosch WA, Lemij HG. Blepharoptosis induced by prolonged hard contact lens wear. Ophthalmology 1992; 99:1759.
  19. Bernardino CR, Rubin PA. Ptosis after cataract surgery. Semin Ophthalmol 2002; 17:144.
  20. Feibel RM, Custer PL, Gordon MO. Postcataract ptosis. A randomized, double-masked comparison of peribulbar and retrobulbar anesthesia. Ophthalmology 1993; 100:660.
  21. Linberg JV, McDonald MB, Safir A, Googe JM. Ptosis following radial keratotomy. Performed using a rigid eyelid speculum. Ophthalmology 1986; 93:1509.
  22. Fujiwara T, Matsuo K, Kondoh S, Yuzuriha S. Etiology and pathogenesis of aponeurotic blepharoptosis. Ann Plast Surg 2001; 46:29.
  23. Walton KA, Buono LM. Horner syndrome. Curr Opin Ophthalmol 2003; 14:357.
  24. Burns TM, Russell JA, LaChance DH, Jones HR. Oculobulbar involvement is typical with Lambert-Eaton myasthenic syndrome. Ann Neurol 2003; 53:270.
  25. Elrod RD, Weinberg DA. Ocular myasthenia gravis. Ophthalmol Clin North Am 2004; 17:275.
  26. Abe K, Matsuo Y, Kadekawa J, et al. Measurement of tissue oxygen consumption in patients with mitochondrial myopathy by noninvasive tissue oximetry. Neurology 1997; 49:837.
  27. Taivassalo T, Jensen TD, Kennaway N, et al. The spectrum of exercise tolerance in mitochondrial myopathies: a study of 40 patients. Brain 2003; 126:413.
  28. Schmiedel J, Jackson S, Schäfer J, Reichmann H. Mitochondrial cytopathies. J Neurol 2003; 250:267.
  29. Perry JD, Kadakia A, Foster JA. A new algorithm for ptosis repair using conjunctival Müllerectomy with or without tarsectomy. Ophthal Plast Reconstr Surg 2002; 18:426.
  30. Frueh BR, Musch DC, McDonald HM. Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology 2004; 111:2158.
  31. Finsterer J. Ptosis: causes, presentation, and management. Aesthetic Plast Surg 2003; 27:193.
  32. Erb MH, Kersten RC, Yip CC, et al. Effect of unilateral blepharoptosis repair on contralateral eyelid position. Ophthal Plast Reconstr Surg 2004; 20:418.