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Ptose Congênita (Pálpebras Caídas)

Definição e causas

"Ptose" é o termo médico para uma pálpebra superior caída. Há duas razões pelas quais uma pálpebra cai: há um problema com os músculos elevadores que levantam as pálpebras, ou um problema com o nervo que os controla. Há várias causas - trauma, infecção, câncer, doença autoimune ou inflamatória, e às vezes a ptose pode ser hereditária.

É causada por uma disfunção tanto nos músculos que levantam a pálpebra, quanto nos nervos que controlam esses músculos. A ptose pode ocorrer por si só, mas também pode estar associada a trauma, doença autoimune ou inflamatória, infecção, câncer e, em alguns casos, doença hereditária.

Às vezes, a ptose é leve, e a pálpebra superior cai apenas ligeiramente. Mas em casos moderados a graves, a pálpebra superior pode cobrir parcial ou completamente a pupila. Isto é particularmente preocupante em crianças, a ptose que cobre a pupila pode causar ambliopia: a parte do cérebro que lida com a visão daquele olho simplesmente não se desenvolve adequadamente, pois não está recebendo tanta informação deste olho parcialmente fechado.

Instintivamente, as crianças tentam compensar isso através dos seguintes comportamentos:

  • Colocando a cabeça para trás e levantando o queixo
  • Levantando a pálpebra caída com seus dedos
  • Levantando a sobrancelha para ajudar a levantar mais a pálpebra superior.

Mas se você tem uma criança com uma pálpebra que cobre a pupila e eles não usam estes mecanismos compensatórios, então é importante que eles sejam vistos por um profissional rapidamente: a ptose pode causar supressão visual, e pode deixar sua criança com ambliopia permanente e vitalícia.

A ptose congênita é geralmente baseada em uma má formação do músculo (músculo elevador), que deve elevar a pálpebra superior. Esta alteração pode afetar uma ou ambas as pálpebras superiores. Outras causas mais raras de ptose congênita podem incluir: certas doenças musculares, tumores das pálpebras ou distúrbios neurológicos.
 

A operação

There are two surgical techniques that can be used to correct ptosis – levator resection and frontal suspension. Which one is chosen depends on the condition of the levator muscle and the extent of ptosis. After we examine you, we will discuss the findings together with you and plan the further procedure for you (or your child).

Levator resection

If the function of the levator muscle is still relatively intact, we will suggest what’s called levator resection: the levator muscle is shortened and strengthened. We do this by making a cut in the eyelid crease, then shortening the levator muscle by a predetermined and precisely defined length. The incision is later closed with self-dissolving stitches, and the entire operation is performed under general anaesthesia

Frontalis suspension

If the function of the levator muscle is weak, we typically perform what’s called frontalis suspension surgery. The surgeon places a sling under the muscle and connects it with the eyebrow. This loop is inserted through small, approximately 5 mm-long punctures over the eyebrows and in the upper lid area. This sling is then tightened until the position of the upper lid reaches the desired height. The punctures on the eyebrows are closed with self-resecting sutures – those in the eyelid heal without suture. The operation is performed under general anaesthesia.

When to operate?

If the ptosis is mild and the eye is not in danger of developing amblyopia, the operation can be postponed, and we will monitor the situation before intervening. However, we would suggest that the operation be considered at the onset of puberty, in order to relieve the psychological pressure on your child that other children might place on your child.
However, if your child’s vision is at risk, early surgery is needed to support normal vision and prevent amblyopia.

The “perfect” symmetry

We aim for perfection, but it’s important to realize that in about 15% of cases where we’ve operated on one or two eyelids, we might have a good result, but thanks to the healing processes potentially changing lid height, the patient might still end up with a small asymmetry between the eyelid opening height of both eyes. Having said that, these small differences are natural – many people have this, and this should be tolerated, especially because the final lid height is only stable after about 6 months after surgery – until then, it might appear that there is under- or over-correction. If there is still a clear difference after 6 months (> 2mm), then, if appropriate, we will suggest a re-operation.

Lid Lag

In acquired ptosis in adulthood, the levator muscle functions normally and “only” needs to be raised to the correct height. In children with congenital ptosis, the eyelid muscle doesn’t work sufficiently well enough to lift the eyelid completely. Raising the muscle alone is not enough: the muscle must be shortened. This results in a normal-looking eyelid height when looking straight ahead, but the upper eyelid “stops” moving below that level when looking down. This is called “lid lag” and unavoidable – but your child will learn to compensate for this after surgery so that the lid lag is not too noticeable.

Our Results

Antes de
Depois
ANTERIOR
Acquired Ptosis
ANTERIOR
SEGUINTE
Eyelid Changes in Facial Palsy
SEGUINTE

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Augeninstitut ELZA
4.8
Como base em 109 críticas
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mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100%... achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!ler mais
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!ler mais
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!ler mais
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!ler mais
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.ler mais
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youler mais
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.ler mais
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!ler mais
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.ler mais
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.ler mais
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4.8
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