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},
"code": "H02.2",
"name": "Лагофтальм",
"icd_name": "Лагофтальм",
"gender": 0,
"age_min": 20,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h02.2_lagoftalm",
"lead": "офтальмологическое заболевание, при котором человек не может полностью сомкнуть веки",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Паралич лицевого нерва считается главной причиной образования лагофтальма. Патология возникает в результате:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">травм лица либо переломов основания черепа;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">выпячивания стенки артерии (аневризмы сосудов головного мозга), инсульта;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">воспаленной околоушной слюнной железы;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">опухолей мостомозжечкового угла (сюда относится доброкачественная опухоль, появляющаяся из шванновских клеток вестибулярного нерва, а также опухоль, возникающая из шванновских клеток оболочки нерва);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">инфекционных болезней, к которым относят ветряную оспу, полиомиелит, инфекционный паротит и другие болезни;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">некачественно проведенных пластических операций на лице;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">заболеваний среднего уха;</span></li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">За плотное смыкание век отвечают круговые мышцы глаза. Однако по ряду причин связь этих мышц с центральной нервной системой может нарушиться, из-за чего они перестают сокращаться, что запускает механизм развития лагофтальма.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Независимо от причины нарушения иннервации круговой мышцы, основным фактором патогенеза болезни является нарушение естественной защитной функции век. Из-за неспособности совершать спонтанные мигательные движения происходит чрезмерное испарение слёзной плёнки с поверхности роговицы. Слезотечение или синдром сухого глаза, невозможность сомкнуть глазную щель, рецидивирующие инфекции глаз лишь увеличивают риск повреждения роговицы и нарушения зрения.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При наружном осмотре пациента диагноз обычно не вызывает сомнения. Для установления причины заболевания необходим тщательный сбор анамнеза: наличие общих заболеваний, предшествующие операции, травмы, перенесенные инфекционные болезни. Правильный опрос поможет выбрать алгоритм лечения каждого конкретного пациента и, если необходимо, привлечь смежных специалистов (невролога, эндокринолога, оториноларинголога, нейрохирурга и др.).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При осмотре пациента врач должен оценить функцию мышц, отвечающих за смыкание век и поднимание верхнего века, определить тонус век. Для этого по просьбе доктора пациент смыкает веки сначала без напряжения, а затем с усилием.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Офтальмологическое обследование необходимо для фиксации нарушений зрительных функций, определения патологических изменений переднего отрезка глазного яблока и выбора дальнейшей лечебной тактики. Оно проводится офтальмологом и включает следующие исследования: визометрия, биомикроскопия, эхоскопия, оптическая когерентная томография переднего отрезка глазного яблока и др.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозная терапия направлена на своевременное увлажнение орбитальной поверхности органа зрения. Основная цель – предупреждение развития ксерофтальмии. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациентам показаны инстилляции:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Антисептических медикаментов. Регулярное повторение процедуры необходимо для предупреждения инфекционных и воспалительных осложнений.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Увлажняющих средств. Ежедневное использование препаратов позволяет избежать осложнений, дает возможность компенсировать основные симптомы на ранних этапах развития.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Препаратов искусственной слезы. Данная группа лекарственных средств применяется при развитии лагофтальма на фоне патологии тройничного нерва, что обусловлено нарушением слезопродукции.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Противовоспалительных средств. Препараты рекомендованы только в случае диагностики инфекционных или воспалительных заболеваний (конъюнктивита, кератита, блефарита).</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативные способы коррекции положения век сводятся к применению пластырных повязок. Методика отличается экономичностью и простотой применения, но не обеспечивает долговременного эффекта. Целью операции является восстановление полного смыкания глазной щели. Особенности хирургического лечения определяются этиологией. При лицевом параличе применяются реконструктивные вмешательства. Невролиз позволяет выделить нерв из рубцовых тканей, обуславливающих его компрессию. Возможна аутотрансплантация или реиннервация, при которой дистальный отдел лицевого нерва сшивают с центральным отделом добавочного или подъязычного.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Коррекцию положения и сужение глазной щели обеспечивает тарзо- и блефарорафия. Менее травматично проведение через веко специальной нити в натянутом состоянии. Доказана эффективность применения монолитных платиновых или золотых имплантатов. При наличии противопоказаний к имплантации выполняют рецессию леваторов. Если лагофтальм сопровождается паралитическим выворотом, рекомендовано осуществление кантопластики. Паллиативное лечение сводится к инъекции в область верхнего века гиалуроновой кислоты или ботулинического токсина для его опущения.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфической профилактики лагофтальма не существует. Неспецифические профилактические меры включают в себя исключение всех потенциальных этиологических факторов – своевременное лечение различных инфекционных и аутоиммунных заболеваний, поражений среднего уха и т. д. Для предотвращения развития осложнений проводятся инстилляции увлажняющих средств.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На начальных стадиях заболевание проявляется неполным смыканием глазной щели с сопутствующей сухостью конъюнктивы. Пациенты отмечают слезоточивость, чувство жжения и покраснение конъюнктивы. Прогрессирование лагофтальма приводит к тому, что верхнее веко не опускается и не принимает участия в моргании. Гиперемия орбитальной конъюнктивы наиболее выражена в утреннее время, т. к. во время сна глазная щель открыта. Больные предъявляют жалобы на «затуманивание» зрения. Повышенное слезотечение при лагофтальме сопровождается фотофобией. При потере корнеального рефлекса раздражение роговицы не вызывает смыкания глаз.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клиническое течение заболевания зависит от этиологии. Паралич круговой мышцы провоцирует развитие эктропиона. Смещение слезной точки проявляется повышенным слезотечением, ранним появлением симптомов блефарита или вялотекущего конъюнктивита. Возникновение лагофтальма при поражении тройничного нерва характеризуется нарушением слезопродукции. Повреждение VII пары черепных нервов вызывает чувство сухости и ощущение инородного тела. Длительное существование паралича потенцирует прогрессирование атрофических изменений, проявляющихся снижением тургора век, их смещением книзу или выворотом.</span></p>",
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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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"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Главной причиной возникновения птоза является нарушение мышцы, поднимающей верхнее веко. Тем не менее, имеются и другие возможные причины возникновения заболевания:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Старение тканей, растяжение мышцы, поднимающей верхнее веко. Мышца не выполняет свои функции, что затрудняет полное раскрытие глаза.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патология нервной системы, влияющая на работу леватора (мышца, поднимающая верхнее веко).</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Снижение внутриглазного давления.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наличие кисты или опухоли придаточного аппарата глаза и структур головного мозга.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пластические операции.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эндокринные заболевания.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">За поднятие века отвечает леватор и мышца Мюллера. Главной мышцей, поднимающей веко, является леватор. Он связан с глазодвигательным нервом. Спереди данная мышца прикреплена к коже верхнего века, снизу — к передней поверхности верхней тарзальной пластинки, вверху — к своду конъюнктивы. Общая длина мышцы примерно 54-60 мм. Длина апоневроза леватора (именно он непосредственно крепится к тарзальной пластинке) примерно 14-20 мм. У верхнего края тарзальной пластинки (хряща века) непосредственно отдаёт волокна к коже, что формирует складку верхнего века.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мышца Мюллера находится сразу над леватором апоневроза. Её размеры составляют около 20 мм. Она прикрепляется также к верхней тарзальной пластинке, при сокращении поднимает верхнее веко примерно на 2 мм. Так как данная мышца получает иннервацию от симпатических волокон, она отвечает за развитие блефароптоза при синдроме Горнера.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Приобретённый блефароптоз возникает чаще всего при нарушении анатомической целостности и/или функции вышеуказанных мышц (в том числе вследствие нарушения иннервации).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врождённый птоз чаще связан с миодистрофией и недоразвитием леватора, но иногда он возникает в связи с врождённой неврологической патологией и травмой, которую ребёнок получил во время родов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Псевдоптоз может развиваться вследствие избытка кожи верхнего века или в связи с ретракцией (сокращением) кожи верхнего века с одной стороны. Это создаёт впечатление развития птоза на противоположной стороне (например, при эндокринной офтальмопатии).</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Осмотр пациента у врача-офтальмолога при данном заболевании, как правило, включает в себя:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Сбор анамнеза, для более точного диагностирования причины заболевания;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Измерение ширины глазной щели (расстояния между краями верхнего и нижнего века);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Исследование глазного дна для оценки остроты зрения;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Проведение биомикроскопии с целью определения состояния слезной пленки, роговицы и конъюнктивы.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для наиболее полной диагностики с целью исключения кист и опухолей придаточного аппарата глаза и головного мозга, могут быть проведены следующие инструментальные исследования:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">УЗИ придаточного аппарата глаза и орбиты;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">МРТ головного мозга с исследованием кровотока;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">КТ головного мозга;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">КТ орбит.</span></li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В первую очередь, лечение птоза верхнего века направлено на устранение функциональной патологии и лишь затем – на коррекцию косметического дефекта.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В случае неврогенного характера опущения верхнего века проводится лечение основной патологии; дополнительно назначается местная физиотерапия - гальванизация, УВЧ, парафинотерапия.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При врожденном опущении верхнего века, а также отсутствии эффективности от консервативной терапии приобретенного птоза в течение 6-9 мес., прибегают к методам хирургической офтальмологии. Сроки коррекции врожденного блефароптоза устанавливают дифференцированно: частичное опущение верхнего века оперируют в 13-16 лет; полный птоз, ввиду вероятности развития амблиопии, целесообразно устранять в дошкольном детстве.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Операции по поводу опущения верхнего века (исправление птоза) направлены либо на укорочение мышцы, поднимающей верхнее веко (врожденный птоз), либо на укорочение апоневроза леватора (приобретенный птоз).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При врожденном птозе производится выделение леватора, пликация (укорочение) мышцы путем ее иссечения или создания дупликатуры. В случае выраженного блефароптоза мышцу, поднимающую веко, подшивают к лобной мышце.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Стандартная операция по поводу приобретенного блефароптоза заключается в удалении тонкой полоски кожи верхнего века, резекции апоневроза и фиксации его нижнего края к хрящу верхнего века. В пластической хирургии коррекция опущения верхнего века может сочетаться с верхней блефаропластикой.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К профилактическим мероприятиям можно отнести знание симптомов и регулярные осмотры у офтальмолога. В случае развития птоза, как проявления системного заболевания, профилактика должна быть направлена на предотвращение развития основного заболевания. Некоторые виды, такие как врождённый птоз или псевдоптоз, обусловленный избытком кожи верхнего века, нельзя предотвратить профилактическими мероприятиями.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Распространенными симптомами заболевания являются:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Частичное или полное опущение края верхнего века, что приводит к ухудшению качества зрения и головным болям;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Запрокидывание головы назад, для облегчения раскрытия глаза;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Снижение остроты зрения, появление косоглазия;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Постоянная усталость глаз;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Раздвоение предметов перед глазами.</span></li>\r\n</ul>\r\n<p><span id=\"docs-internal-guid-24579b6a-7fff-91b2-a9ac-f4805f000ecd\"> </span></p>",
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]
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