眼皮鬆弛還是眼瞼肌無力?

28歲的陳小姐,常常在上班的時候被同事問:為什麼那麼沒精神?她覺得自己明明睡得很飽、精神很好,不曉得為什麼眼睛就是張不開,給人沒有精神的感覺。

30歲的張小姐,從小眼睛就一大一小,比較小的右眼就是特別無神,她總是習慣把頭髮側分,遮住比較無神的右眼。她常常在想,如果雙眼都可以一樣明亮有神,那該有多好?

34歲的林小姐,年紀輕輕,額頭上卻有很多的抬頭紋,但是他看自己的媽媽、姐妹,都沒有這樣的問題,為什麼自己每次睜開眼睛,都會不自覺得抬下巴或用力的提眉睜眼呢?

提上眼瞼肌無力找上門了?

上眼皮打開的機制,主要是靠兩條肌肉:提上眼瞼肌、苗勒氏肌(Muller muscle)(圖一),當它們收縮時,可以拉動上眼瞼板,使上眼皮打開。

正常的眼睛往前看時,上眼皮大約會蓋住黑眼珠 1-2mm;上眼皮張開不全蓋住黑眼珠超過 2mm,則有可能伴隨著提上眼瞼肌無力的問題,這是顯性的提上眼瞼肌無力。有的人訓練自己用前額肌把眉毛拉高,也可以連帶拉高眼皮,來改善眼皮打不太開的困境,這還是有上眼瞼肌無力的問題。這些隱性的病人,眼睛閉起來的時候,眉毛會回到正常高度,但只要眼睛一打開,眉毛就會挑高,額頭的皺紋就會出現。

上眼皮下垂—-是皮膚鬆弛還是眼瞼肌無力?

眼皮下垂常見的原因有兩個:提眼瞼肌無力(圖二)和皮膚鬆弛(圖三)。在接受手術之前一定要評估清楚,如果是提眼瞼肌無力需要提眼肌手術,光修短皮膚是沒辦法改善的。而年紀大的患者,會有皮膚鬆弛變多的情形,術前評估好提上眼瞼肌的功能,以免只做修剪贅皮,術後就可能變成大小眼,或是依然眼瞼下垂;如果皮再切得更多,患者眼睛既睜不開、也閉不緊。

可以自我檢測

除了上眼皮的下緣遮住黑眼球;如果眉毛位置很高、額頭有很多抬頭紋的,比較是提上眼瞼肌的問題(圖二);如果眉毛位置與閉眼時差不多的,比較是贅皮的問題(圖三)。有疑問還是需由專業眼科醫師來做判斷。

提上眼瞼肌無力的治療

提上眼瞼肌無力造成的原因很多,排除內科問題後,可由手術治療。在幼兒 因遮蔽視線或造成散光而影響視力、或在成人因遮蔽視線、疲勞、無神和外觀需求,可藉由手術讓眼睛更神采奕奕。

眼瞼下垂的手術有非常多種,眼科醫師會依據病患提上眼瞼肌的功能、是不是二次以上手術、以及病患個人狀況,採用不同的作法,所以患者在接受手術前,一定要找專業的醫師做評估,手術的安全是最重要的。

 

1,240 thoughts on “眼皮鬆弛還是眼瞼肌無力?”

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