Partial or total inability to lift the upper eyelid due to incomplete or lost function of the levator muscle, or other causes, obscuring part or all of the pupil is called ptosis. Classification 1. Congenital ptosis. This accounts for about 80% of all classifications and is due to abnormal development of the levator muscle resulting in its diminished function or even loss. Among these, microtia syndrome is a congenital syndrome that includes ptosis. 2. Acquired ptosis. This is due to ophthalmoplegia or myasthenia gravis; 3. Pseudopelvic ptosis. The upper eyelid is drooping in appearance, but the function of the levator muscle is normal on objective examination and the true position of the upper eyelid is normal. This is commonly due to laxity of the upper eyelid skin, lack of support of the upper eyelid, idiopathic blepharospasm, and ocular muscle fibrosis. 4. Combined eyelid movements refer to eyelid movements associated with jaw, face and eye movements. For example, transient masticatory syndrome. Clinical manifestations 1. Congenital ptosis, as the name implies, is present at birth, with little opening of one or both eyes, and in more obvious cases the eyelid skin is smooth, thin and wrinkle-free. If the pupil is obscured by the eyelid, the patient tries to overcome the visual impairment by tightening the frontalis muscle, creating deep transverse skin wrinkles that pull the eyebrows upward in an arch-like projection, thereby raising the upper lid margin, or the patient tilts the head to see. In this case, microphthalmos syndrome, also known as microphthalmos, is a congenital genetic condition in which the eyelids are extremely small and the distance between the inner and outer canthus is extremely short, with the typical tetrad of bilateral ptosis, narrow lid fissures, inverted medial canthus, and widened medial canthal spacing. The most common form of acquired ptosis is myogenic ptosis caused by myasthenia gravis. This is often accompanied by generalized fatigue of the random muscles. However, there are also cases where the ptosis is purely in the extraocular muscles and does not progress to other muscles over time. This type of ptosis is characterized by improvement after rest, immediate aggravation during continuous transient eyes, light in the morning and heavy in the afternoon, and temporary relief of symptoms after subcutaneous or intramuscular injection of neostigmine 0.3 to 1.5 mg for 15 to 30 minutes. 3. Pseudophakic ptosis is noteworthy for the limited upturn of the eye due to ocular muscle fibrosis, which manifests as ptosis of the affected eye. 4. Transient masticatory syndrome. This is a congenital abnormal connection between the nucleus accumbens and the motor nucleus of the trigeminal nerve, resulting in a joint movement of the external pterygoid muscle and the levator muscle, with symptoms such as lifting of the upper eyelid by opening the mouth or swinging the jaw, and obviously a transient movement with chewing while eating. The fundamental goals of ptosis surgery are to raise the ptosis, restore normal lid height, expose the pupil, expand the visual field, prevent amblyopia, correct the abnormal shape, and improve facial appearance. In short, it is important to achieve both functional restoration and cosmetic purposes. Treatment 1. Congenital ptosis requires surgical treatment. The best time to operate is between 2.5 and 3 years of age, but if the ptosis is severe, surgery can be considered at age 2. The surgical procedure can be done by ① enhancing the strength of the levator muscle, such as shortening or migrating the anterior muscle. ②Opening the lid fissure with the help of the traction force of the frontalis muscle. The surgical procedure can be chosen according to the condition and the strength of each muscle. 2. Myogenic ptosis due to myasthenia gravis does not require surgery and needs to be treated with oral bromelain tablets and prednisone. 3. Ptosis due to fibrosis of the eye muscles. Surgery of the extraocular muscles is required to resolve the limited upward rotation of the eye. 4. Small lid fissure syndrome needs to be treated with second stage surgery. One stage corrects the medial canthus and the second stage corrects the ptosis. Complications Watch out for the occurrence of postoperative exposure keratitis.