Sympathetic ptosis | Causes of ptosis

Sympathetic ptosis

The term sympathetic ptosis is used when the sympathetic nervous system (involuntary/vegetative nervous system) that controls the tarsalis muscle is damaged originally or on its way to the eye. This takes a complicated course, starting from the spinal cord at the level of the thoracic vertebrae, where a direct switch takes place and leads as the truncus vagosympathicus to the carotid artery. Diffusely surrounding the arteries of the head, the sympathetic nervous system spreads to its target organs in the head.

Possible causes along this route are damage to or disease of the cervical or thoracic spine, an infarct in the brain stem or spinal cord, a tumor disease affecting the nerve pathways, a dissection of the carotid artery (tearing of the inner wall of the vessel), an aortic aneurysm, or a goiter or tumor of the thyroid gland. A medical intervention in the area of the sympathetic nervous system can also unintentionally cause the symptoms, as is the case with certain headache disorders (headaches) which are accepted as a therapeutic consequence. If the sympathetic nervous system is damaged on its way to the eye, the combination of symptoms results in the classic “Horner triad”, consisting of ptosis, miosis (small pupil position due to the predominance of the parasympathetic nervous system in the eye) and endophthalmos (sinking of the eyeball into the eye cavity) (ptosis causes).

Diseases of the skeletal muscles of the body can also cause ptosis.Sometimes it provides a first indication of such a disease, as in myasthenia gravis, in which antibodies are formed against parts of the skeletal muscle cells (usually against the acetylcholine receptor that activates the cell) and thus disturb their function. Increased blinking can lead to unilateral or bilateral ptosis in myasthenia gravis patients in the early stages of the disease, or the subtly drooping eyelid can lead to a corrective posture of the head or frowning in order to see without disturbance. Another example of a possible disease is myotonic dystrophy, which is inherited autosomal-dominantly and occurs as an early form after birth or as a late form usually between the ages of 10 and 30 years.

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, poisoning can cause ptosis (ptosis causes), if, for example, botulinum toxin (Botox) prevents the nervous signal transmission to the muscle in the context of food poisoning or as a side effect of a medical or cosmetic application – some poisons from the animal kingdom (e.g. snake venoms) can also be considered. Furthermore, an injury of the muscle tarsalis or of the muscle levator palpebrae superioris (formerly, for example, birth trauma by forceps or the like), as well as their age-related degeneration, as well as tumor or inflammation is a possible cause for ptosis (ptosis causes).

The use of Botox has increased in recent years, both in the treatment of strabismus and in cosmetic applications to remove wrinkles or similar. The reason for its use is the poison botolinum toxin. This nerve toxin is extracted from the bacterium Chlostridium botulinum and leads to an inactivation of nerve cells.

This results in a low transmission of excitation to the cells and finally in a slackening of the muscles. Poisoning occurs, for example, in the course of food poisoning or a complication during a cosmetic Botox procedure. When treating wrinkles around the eye or a cramping of the eyelid, an overdose of the Botox agent may occur.

As a result, too many nerve cells are inactivated and this leads to increased muscle weakness. If this weakness affects the muscles of the upper eyelid, the side effect is ptosis.