The upper eyelid is lifted together by two different muscles and thus the eye is opened, the muscle levator palpebrae superioris (innervated voluntarily by the oculomotor nerve) and the tarsalis muscle (innervated involuntarily by the sympathetic nervous system). The latter works noticeably less when tired, as the activity of the sympathetic nervous system decreases accordingly and it is difficult to keep your eyes open (causes of ptosis).
As Causes of Ptosis come all innate and acquired damage on the route between the brain area of one of the two eyelid lifters Muscles, on the way of the competent annoy, down to the individual muscles themselves (causes of ptosis).
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As a rare form, the Congenital ptosis. Here she usually kicks one-sided on and has one Underdevelopment or Failure of the core area of the oculomotor nerve, or the muscle itself as the cause. They can be associated with various undesirable development syndromes, but can also occur in isolation due to their own genetically inherited and acquired components. A tumor (mostly as Hemangioma) of the upper eyelid or that Marcus Gunn Syndromein which it becomes a incorrectly applied control between the masticatory muscles and the levator palpebrae superioris muscle can also cause a birth existing ptosis. Regardless of the cause of congenital ptosis, it poses a high risk for the newborn as it progresses Amblyopia (Weak-sightedness), since the visual pathway only fully matures under the first sensory impressions and this is not possible if the iris is partially or completely covered. For this reason, congenital ptosis is operated on at an early stage.
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If there is damage to the voluntary nerve pathways on the stretch between the ocular muscle nuclei and the muscles (Oculomotor nerve), one speaks of a paralytic ptosis. It can also be triggered by a reduced blood supply to the cranial nerve nucleus area in the brain stem, but is then usually accompanied by other symptoms. A Compression of the nerve by a tumor or a Aneurysm in the brain stem area or in the further course, as well as accident-related, traumatic damage are possible (ptosis causes).
At Increase in intracranial pressure can it to Entrapment of the oculomotor nerves come at the base of the skull. A Cavernous Sinus Syndromewhere it goes through thrombosis, Vascular abnormalities, inflammatory processes or other neoplasms A mass in the venous cistern called the cavernous sinus, located behind the eye cavities and in the vicinity of the sphenoid sinus, also leads to impairment of the oculomotor nerve, but also various other nerves. Since the oculomotor nerve is also almost all other internal and all external Eye muscles controls, damage leads not only to ptosis, but at the same time Double vision through certain squint patterns, Accommodation difficulties and increased sensitivity to light due to the disturbed closure of the iris (causes of ptosis).
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From one sympathetic ptosis is the talk when that the Tarsalis muscle approaching, sympathetic nervous system (involuntary / vegetative nervous system) is damaged originally or on its way to the eye. This takes a complicated course, starting from Spinal cord at thoracic vertebra level, where a switchover takes place directly and it as Truncus vagosympathicus to Carotid artery leads. The sympathetic nervous system spreads diffusely around the arteries of the head to its target organs in the head. The cause on this route is damage or illness of Cervical or thoracic spine, a Infarction in the brain stem or Spinal cord, a tumor that affects the nerve flow, a Dissection of the carotid artery (Tear of the inner wall of the vessel), a Aortic aneurysm, or a Goiter or Thyroid tumor conceivable. Also a medical intervention in the course of the Sympathetic can be unintentional, as with certain Headache disorders (a headache) accepted as a therapy consequence that cause symptoms. In the case of damage to the sympathetic system on its way towards the eye, the so-called classic symptom combination occurs "Horner triad", consisting of Ptosis, Miosis (Lowering the pupil due to the preponderance of the parasympathetic nervous system on the eye) and Endophthalmos (Sinking of the eyeball into the eye cavity) (Causes of ptosis).
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Diseases of the Skeletal muscles of the body can also cause ptosis. Sometimes it offers a first indication of such a disease, like one Myasthenia gravis, in which antibodies against parts of the skeletal muscle cells (mostly against the acetylcholine receptor that activates the cell) are formed and disrupt their function. Increased blinking can lead to unilateral or bilateral ptosis in a myasthenic patient even in the early phase of the disease, or the subtly drooping eyelid leads to a corrected posture of the head or to a frown in order to be able to see undisturbed. An example of another possible disease is this Myotonic dystrophy, the autosomal dominant is inherited congenitally and usually as an early form after birth or as a late form between the ages of 10 and 30 occurs. Due to the genetic defect, a muscle enzyme is produced in insufficient quantities, which leads to damage to muscle cell membranes and calcium pumps. Likewise, a poisoning cause ptosis (causes of ptosis) if, for example Botulinum toxin (Botox) as part of a Food poisoning or, as a side effect of a medical or cosmetic application, prevents nerve signal transmission to the muscle - some poisons from the animal kingdom (e.g. Snake poisons) can also be considered. Furthermore, an injury to the tarsalis muscle or the levator palpebrae superioris muscle (earlier, for example, birth trauma caused by forceps or the like), as well as their age-related degeneration, as well as tumor or inflammation a possible cause of ptosis (causes of ptosis).
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The use of botox has increased in recent years, both in the treatment of strabismus and in cosmetic use to remove wrinkles or the like.
The reason for the application is the poison botulinum toxin. This neurotoxin is obtained from the bacterium Chlostridium botulinum and leads to the inactivation of nerve cells. This results in a low level of excitation transmission to the cells and ultimately a relaxation of the muscles.
Poisoning occurs, for example, as part of food poisoning or a complication of a cosmetic botox procedure. When treating wrinkles around the eyes or eyelid cramps, an overdose of the botox can occur. This inactivates too many nerve cells and leads to increased muscle weakness. When this weakness affects the muscles of the upper eyelid, the side effect of ptosis occurs.
