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"lead": "Опущенное верхнее веко или птоз - (от др.-греч. πτῶσις «падение», также: птоз верхнего века, блефароплегия, блефароптоз)[3][4] — патологическое низкое положение верхнего века по отношению к глазному яблоку вследствие его опущения.\r\nРазновидности\r\n\r\nПолный врождённый правосторонний птоз\r\nОдносторонний или двухсторонний\r\nВрождённый или приобретённый\r\nПолный или частичный\r\nПричины\r\nПричиной врождённого птоза является недоразвитие или отсутствие мышцы, поднимающей верхнее веко.\r\nПричиной приобретённого птоза являются, помимо травм, многие неврологические заболевания (инсульт, энцефалит и др., часто в рамках синдрома Горнера), ведущие к парезу или параличу глазодвигательного нерва, иннервирующего мышцу, поднимающую верхнее веко.\r\nДиагностика\r\nПри оценке степени птоза пользуются параметром MRD — расстоянием между краем верхнего века и центром зрачка в мм. Так, если край века проходит через середину зрачка — это MRD = 0 мм, если край века выше середины зрачка, то MRD может быть от +1 до +5, +6, если ниже середины зрачка, то MRD будет — 1-5 мм.\r\n\r\nПри определении степени птоза и подвижности верхнего века важно фиксировать брови пациента в расслабленном положении, так как нередко удается открывать глаз с полным птозом до состояния, походящего на птоз 2-й и даже 1-й степени за счёт сильного напряжения лобной мышцы и бровей.\r\n\r\nУ детей малого возраста особенно важно определить есть ли амблиопия, так как сниженное зрение — показание к коррекции птоза. Если речь идёт о ребёнке до 2-3 лет, когда определение остроты зрения по оптотипам не представляется возможным по понятным причинам, можно заподозрить наличие сниженного зрения, оценивая реакцию ребёнка на прикрывание «хорошего» глаза, при условии, что веко на глазу с птозом принудительно открыто (например пластыревой подвеской). Так, при сниженном зрении на стороне поражения ребёнок будет негативно относиться к прикрыванию здорового глаза — отталкивать руку, плакать и т. п. Значит, глаз видит существенно хуже.\r\n\r\nДалее важно оценить силу леватора, экскурсию века, высоту и вид пальпебральной складки, напряжённость бровей, наличие лагофтальма, феномен Белла и продукцию слезной жидкости. Внимательно осматривают роговицу, чтобы выявить любые поражения или проявления дистрофии, которые могут предрасполагать к послеоперационной кератопатии у пациента. Экзофтальм или «отставание» века может создавать впечатление о наличии птоза на парном глазу. Поэтому полезно выполнить экзофтальмометрию.\r\n\r\nЛечение\r\nЛечение птоза подразделяется на консервативное и хирургическое. Консервативному лечению подлежит нейрогенный птоз. Терапия направлена на восстановление функции нерва. Применяется местная УВЧ терапия, гальванотерапия, препараты для питания нервной ткани. В отсутствие эффекта от консервативного лечения нейрогенного птоза и во всех остальных случаях прибегают к хирургическому лечению.\r\n\r\nВажным этапом в ожидании оперативного лечения у детей младшего возраста с птозами 2-й и 3-й степени является подвешивание верхнего века к коже лба с помощью лейкопластыря. Эта манипуляция имеет плохой косметический эффект и создаёт определённые неудобства, но позволяет избежать депривации и развития амблиопии, а также выиграть время для подготовки ребёнка к хирургическому лечению. Важно обучить родителя правильной технике выполнения данной манипуляции: слегка потянуть верхнее веко вниз, для расправления имеющихся складок кожи, узкую (1 см) полоску пластыря одним концом плотно приклеиваем к коже верхнего века в проекции роговицы, отступив от края века на 3—4 мм, подтягиваем полоску пластыря вверх до открытия большей площади зрачка, затем плотно приклеиваем другой конец полоски к коже лба над бровью. При этом следует придерживаться следующих правил:\r\n\r\nне нужно давить на глазное яблоко;\r\nне нужно добиваться строгой симметрии в положении век обоих глаз;\r\nнужно строго следить за тем, чтобы величина неполного смыкания век при спокойном закрытии обоих глаз не была более 2,0—2,5 мм;\r\nиспользовать пластырь-подвеску в период наибольшего времени бодрствования, не менее 3 часов в день;\r\nне использовать во время сна;\r\nпри контактном дерматите отменить пластырь-подвеску, а затем использовать лейкопластырь другой фирмы (или той же);\r\nпротирать кожу влажным тампоном от клейкого вещества после снятия пластыря.\r\nПри невозможности проведения пластыревого подвешивания (ребёнок срывает пластырь, выраженные аллергические реакции, социальная дезадаптация пациента в детском коллективе из-за издевательств по поводу приклееного пластырем века) целесообразно проведение хирургического лечения в сроки от 6 месяцев, поскольку ожидание ранее принятого в России срока проведения хирургического лечения (3—4 года и позже) гарантированно приведёт к развитию стойкой амблиопии.\r\n\r\nПодавляющее большинство случаев птоза лечится хирургическим способом.",
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