Eversion of the Eyelid Paralytic

Eversion (Latin word "eversion") paralytic is a condition in which the upper part of the eyelid completely or partially covers the eye and leads to loss of vision. This complex and rare hereditary defect occurs due to disruption of the connections between the muscles that control eyelid movement. In paralytic ectropion, the muscles responsible for lowering the eyelid are too underdeveloped or function poorly. As a result, the upper part of the lower eyelid cannot fall over the eye and it becomes completely closed.

Eversion of the eyelid can occur in both adults and newborns. In infants it is often combined with strabismus, and in this case the defect is especially noticeable. If a dislocation of the eyelid persists for more than two years, then it becomes clear that it is paralytic, and therefore requires surgical treatment. Paralytic ectropion is very rare - approximately 1 in 65,000

Paralytic eversion of the eyelids - (e. paraliticum) *Ophthalmology* This disease is an abnormality in the mobility of the outer edges of the eyelids. The epithelium of the eyelids has a large surface of contact with the external environment, which leads to infectious diseases in this area. The leading syndrome of paralytic luxation of the eyelids is decreased vision due to impaired lacrimal drainage, obstruction of the palpebral fissure, etc. In our country and abroad, a number of clinics successfully perform surgical interventions to restore proper motility of the eyelids and the function of the fit of their edges. Sometimes surgeons observe a paralytic condition due to weakness of the apparatus for elevating and abducting the eyeball. The examination reveals separate movement of the eyeballs, overhang of the upper eyelid, in which it covers the lower part of the cornea.

**Clinical picture.** Signs: drooping eyelid, which rises from the middle medially in the dorso-caudal direction, medial displacement of the eyelash during movement of the eyeballs (swallow wing symptom), rolling of the eyelid edge through the edge of the orbit with divergence of the flaps (symptom eyelashes), crooked closure of the eyelids, lengthening of the upper and shortening of the lower segments (hypocornea), limitation of internal mobility of the eyeball, hemeralopia. The severity of clinical manifestations does not always correspond to the severity of the pathological process in the internal part of the visual pathway. Poor diagnostic criterion can be compared with the tympanic method for studying cochlear patency. The worse the patency of stem impulses, the lower the threshold stimulation that causes motor spasm should be. However, comparing the normal values ​​of the reaction to contralateral stimulation of 32° to 97° with the changed indicators in children 5-18 years old, it should be noted that this parameter increases with age. The pattern is most clearly observed when the test is carried out to the extent of irritation, which causes a state of overextension or spasm of the internal rectus muscles. In subjects with an unchanged photosensor reaction, the reaction of a more adjacent or sharply increasing binocular stimulus was different compared to the contralateral one. More often it is a fidus effect (a higher frequency of response from one eye compared to the other), less often it is a monocular symptom (stronger responses when one eye is irritated). In a number of cases, a dependence of the concave (due to parasympathetic stimulation) or diffuse (mainly due to autonomic mismatch) nature of the response on the intensity of photostimulation in combination with the so-called cyclopeptic effect was observed. Therefore, there is a direct correlation between the degree of paralysis/paresis and the level of fugue/conductive hyperpathy of visual evoked potentials, which can differ significantly from each other when using different recording techniques. There are different classifications of paralytic changes in the eyelids (Schneider R., Kaplan A., 1986; Kurmanbekov D.K., Chepleeva A.N., 2014). A two-tier classification has been developed: the first system is “for