
tossis (palak)

tossis, jise blaferoptosis key roop mein bhee jaanaa jaataa haye, oopari palak kaa girna yaa girna haye. iss sthiti koo kabhi-kabhi "aalsi aankh" kahaa jaataa haye, lekin yeh shabd aam taur parr aspashtata kii sthiti koo sandarbhit kartaa haye. yadi paryaapt gambhir hoe aur anupachaarit chhod diyaa jaae, tou girane vaali palak anya sthitiyon kaa kaaran bunn sakati haye, jaise kii aspashtata yaa drishtivaishamya, isaliye bachchon mein vikaar kaa ilaaj karna vishesh roop seey mahatvapurna haye isase pahale kii yeh drishti vikas mein hastakshep curr sakey.
yeh shabd yunani shabd 'patan, patan' seey aaya haye.
sanket aur lakshan.
aamtaur parr iss sthiti mein dekhe jaane vaale sanketon aur lakshnon mein shamil hainh
tossis key kuchh jokhim karakon mein shamil hainh
kaaran.
tossis una maanspeshiyon key shithilata key parinamswarup hotaa haye joe palak yaa unaki tantrika aapoorti koo badhaati hain (levter palpebre superioris key liye occulomotor tantrika aur behtar tarsal maanspeshiyon key liye sahaanubhooti tantrika). yeh ack aankh yaa donon aankho koo prabhaavit curr sakata haye aur bujurgon mein adhik aam haye, kyonki palakon kii maanspeshiyaan bigadane lugg sakati hain. jaba bachcha maan key garbh mein hotaa haye tou usake asamanya vikas key parinamswarup bachche janm key samay bhee tossis pradarshit curr sakate hain. janmajaat tossis teen mukhya roopon mein vanshaanugat haye.
janmajaat tossis key kaaran agyaat hain. tossis palak koo oopar uthaane vaali maanspeshiyon koo nuksan, oopari grieva sahaanubhooti ganglion koo nuksan yaa occulomotor tantrika koo nuksan key kaaran hoe sakata haye, joe maanspeshiyon koo niyantrit kartaa haye. iss tarah kii kshati ack antarnihit bimari kaa sanket hoe sakati haye jaise kii madhumeh melitus, ack mastishk tumour, ack pancost tumour (fefde kaa sheersh) aur beemaariyaan joe maanspeshiyon mein kamjori yaa tantrika kshati kaa kaaran banati hain, jaise kii mysthenia gravis yaa occuloferringial muscular dystrophy. kuchh saamp key vish jaise kii kaale mamba key vish key sampark mein aaney seey bhee yeh prabhaav hoe sakata haye.
petosis levetor maanspeshiyon key aponeurosis, tantrika asaamaanyataon, aghaat, soojan yaa dhakkan yaa kaksha key ghaavon key kaaran hoe sakata haye. tantrika-sanchaarak parr hamla karane aur usey samaapt karane vaale autoimmune antibody key parinamswarup levters kii nishkriyata hoe sakati haye.
petosis ack myogenic, neurogenic, aponeurotic, yaantrik yaa dardanaak kaaran key kaaran hoe sakata haye, aur yeh aamtaur parr ack alag tareeke seey hotaa haye. haalaanki, yeh vibhinn anya sthitiyon seey judaa hoe sakata haye, jaise kii pratirakshaatmak, apakshayi yaa vanshaanugat vikaaron key saath-saath tumour yaa sankraman.
adhigrahit tossis aamtaur parr aponeurotic tossis key kaaran hotaa haye. yeh senacence, dehissance yaa levter aponerosis key vighatan key kaaran hoe sakata haye. isake alawa, purani soojan yaa intraocular sergery seey samaan prabhaav hoe sakata haye. lambe samay taka contact lens pahanane seey bhee sthiti key vikas parr ack nishchit prabhaav padata haye.
janmajaat neurogenic tossis koo horners syndrome key kaaran maanaa jaataa haye, jisamen ack halka tossis ipsilateral tossis, iris aur aerola hypopigmentation aur behtar tarsal maanspeshiyon key peresis key kaaran honey vaale enhydrosis seey judaa hoe sakata haye. adhigrahit horner syndrome aghaat, neoplastic upman yaa samvahani roga key baad bhee hoe sakata haye.
aghaat key kaaran honey vaalaa tossis oopari palak lift key anuchhedan yaa tantrika input key vyavadhaan key saath palak key ghaav key baad hoe sakata haye.
tossis key anya karanon mein soojan yaa shalya chikitsa key baad palakon key neoplasm, neurofibroma yaa secatrization shamil hain. umr badhane key saath halka petosis hoe sakata haye. ack girati hui palak ack cerebral aneurism key parinamswarup teesare-enerve pakshaghat key pahale sanketon mein seey ack hoe sakati haye joe anyatha asymptomatic haye, ack sthiti jise occulomotor tantrika pakshaghat key roop mein jaanaa jaataa haye.
drugs.
morphin, oxycodone, heroin yaa hydrocodone jaisi opioid davaaon kii uchch khuraak kaa sevan tossis kaa kaaran bunn sakata haye. pregabalin, ack anticonvalsant dawa, koo halke tossis kaa kaaran banane key liye bhee jaanaa jaataa haye.
tantra.
vibhinn aghaat kaee alag-alag tantron kaa kaaran bunn sakate hain aur unhein prerit curr sakate hain. udaaharan key liye, myogenic tossis kaa parinam levter maanspeshiyon aur/yaa muller kii maanspeshiyon mein seedhi chot seey hotaa haye. doosari or, neurogenic tossis bund sir kii choton yaa dardanaak roop seey pesh kiye gaye neurotoxin (vaashp/madhumakkhi/saamp kaa jahar) yaa botulinum toxin key kaaran hotaa haye joe una karakon key prabhaav key kaaran hotaa haye joe sinai yaa sahanubhutipurna maarg parr hotey hain. rogi kii palakon key bhraman koo seemit karane vaale nishan vaale ootak yaa rogi key dhakkan koo neeche karane key kaaran bhee yaantrik tossis hoe sakata haye. ack anya tantra occulomotor tantrika kii gadbadi haye jisase levter palpebra kamjor hoe jaataa haye, jisake parinamswarup palaken gir jaati hain. mastishk tantrika parr teesari tantrika, jise sahaanubhooti tantrika key roop mein bhee jaanaa jaataa haye, parr dabaav key kaaran mastishk tumour vaale rogi mein bhee tossis hoe sakata haye.
pathology.
mysthenia gravis ack samanya neurogenic tossis haye jise neuromuscular tossis key roop mein bhee vargeekrit kiya jaa sakata haye kyonki pathology kaa sthaan neuromuscular junction parr hotaa haye. adhyayanon seey pataa chalaa haye kii mysthenia gravis key 70 pratishat taka rogi tossis key saath maujood hotey hain, aur inmein seey 90 pratishat rogiyon mein antatah tossis vikasit hoe jaayega. iss mamle mein, tossis ektarafa yaa dweepaksheeya hoe sakata haye, aur isaki gambhirta dinn key dauran dolan karati haye, kyonki thakan yaa dawa prabhaav jaise kaarak hotey hain. iss vishesh prakaar key tossis koo ack tanyata pareekshan aur rakt pareekshan kii madad seey dusaron seey alag kiya jaataa haye. mysthenia gravis key liye bhee vishisht tathya yeh haye kii thhand collinsterres kii gatividhi koo rokti haye, jisase palakon parr burf lagaakar iss prakaar key tossis koo alag karna sambhav hoe jaataa haye. mysthenic tossis vaale rogiyon koo dinn key alag-alag ghanton mein palak key girane mein bhinnata kaa anubhav honey kii sambhavana haye.
occulomotor palsy key kaaran honey vaalaa tossis ektarafa yaa dweepaksheeya hoe sakata haye, kyonki levter maanspeshiyon key liye upa-naabhik mastishk tantra mein ack saajha madhyarekha sanrachana haye. aise mamalon mein jahaan tumour yaa aneurism dwara tantrika key sampeedan key kaaran pakshaghat hotaa haye, isake parinamswarup asamanya ipsilateral papillary pratikriya aur ack badee putali honey kii atyadhik sambhavana hoti haye. cergical thurd nerve palsy kii visheshta ektarafa tossis kii achaanak shuruat aur prakaash mein ack badhee hui yaa sust putali haye. iss mamle mein, see. tii. aiss. yaa aim. aar. aaee. aiss. jaise imaging parikshanon parr vichaar kiya jaanaa chaahiye. shalya chikitsa key vipareet chikitsa tritiya tantrika pakshaghat, aamtaur parr putali koo prabhaavit naheen kartaa haye aur kaee hafton mein dheere-dheere sudhaar kartaa haye. medical thurd nerve palsy key kaaran honey vaale tossis koo thheek karane key liye sergery koo aam taur parr kewal tabhi maanaa jaataa haye jaba aadhe saal key baad tossis aur aucular gatishilata mein sudhaar asantoshjanak hoe. teesari tantrika pakshaghat vaale rogiyon mein levter kaa kaary cumm yaa anupasthit hotaa haye.
jaba horner syndrome key kaaran hotaa haye, tou tossis aamtaur parr myosis aur enhydrosis key saath hotaa haye. iss mamle mein, tossis shaaririk levter palpebre superioris maanspeshiyon key bajaay sahanubhutipurna, swaayatt muller kii maanspeshiyon mein rukawat key kaaran hotaa haye. dhakkan kii sthiti aur putali kaa aakar aamtaur parr iss sthiti seey prabhaavit hotaa haye, aur petosis aam taur parr halka hotaa haye, 2 mimi seey adhik naheen. prabhaavit paksh parr putali chhoti hoe sakati haye. jabaki aankho mein 4 pratishat kokeen daalane seey horner syndrome key nidan kii pushti hoe sakati haye, hydroxymphatamine aaee drop ghaav key sthaan koo alag curr sakate hain.
deerghakaalik pragatisheel baahari netrarog ack pranaaleegat sthiti haye joe aamtaur parr kewal dhakkan kii sthiti aur baahari aankh kii gati koo prabhaavit karati haye, jisamen putali kii gati shamil naheen hoti haye. yeh sthiti lagbhag 45 pratishat myogenic tossis mamalon key liye jimmedaar haye. adhikansh rogiyon mein iss bimari key kaaran vayaskata mein tossis vikasit hotaa haye. iss sthiti key kaaran honey vaale tossis kii ack visheshta yeh haye kii jaba palaken bund hoti hain tou netragolak kaa surakshaatmak oopar kii or badhana bahut kharaab hotaa haye.
nidan.
ack doctor pahale rogi key chikitsa itihas key baare mein prashnon key saath ack shaaririk pariksha karega taaki yeh pataa lagaaya jaa sakey kii kyaa sthiti vanshaanugat hoe sakati haye. ack slitt lamp pariksha ack uchch-teevrata prakaash key saath kii jaati haye joe rogi kii aankho koo karib seey dekhane kii anumati detee haye. doctor ack pareekshan bhee curr sakata haye jisamen adrophonium koo ack nus mein inject kiya jaataa haye, aur sudhaar key parinami sanketon key liye palakon kii nigrani kii jaati haye.
ack drishya kshetra pareekshan kiya jaa sakata haye, joe usa degree kaa aaklan kartaa haye jiss taka tossis behtar drishti koo prabhaavit kartaa haye. kyonki tantrika kshati tossis key sambhaavit karanon mein seey ack haye, netra visheshagya asaamaanyataon key liye rogi kii putali kii jaanch karega. doctor maanspeshiyon key kaary kii bhee jaanch karenge.
netra roga visheshagya mamuli prativart doori koo mapkar palak key drop kii degree koo bhee maap sakata haye, joe putali key kendra aur oopari dhakkan key kinare key beach kii doori haye, saath hii rogi kii levter maanspeshiyon kii taakat aur kaary koo bhee maapata haye. iss pareekshan mein yeh maapane key liye kii jaba rogi neeche kii or dekh rhaa hotaa haye tou palak kitni door taka jaati haye, saamane kii maanspeshiyon koo pakadana shamil hotaa haye.
inn parikshanon key madhyam seey, netra visheshagya thheek seey tossis kaa nidan curr sakata haye aur isake vargeekaran kii pehchaan curr sakata haye, aur upchaar key pathyakram key baare mein ack nirdhaaran kiya jaa sakata haye, jisamen shalya chikitsa shamil hoe sakati haye.
vargeekaran.
kaaran key aadhar parr, tossis koo nimn mein vargeekrit kiya jaa sakata haih
upchaar.
yadi drishti mein hastakshep karane key liye paryaapt gambhir haye yaa yadi upasthiti ack chinta kaa vishay haye tou aponeurotic aur janmajaat tossis koo shalya chikitsa sudhaar kii aavashyakta hoe sakati haye. upchaar tossis key prakaar parr nirbhar kartaa haye aur aamtaur parr ack netra plastic sarjan yaa rogon aur palak kii samasyaon mein visheshagyata rakhane vaale punarnirmaan sarjan dwara kiya jaataa haye.
yadi sthiti ack bachche mein hoti haye, tou doctor sergery mein taba taka deree karega jaba taka kii rogi 4 yaa 5 saal kaa naa hoe jaae. yadi rogi shalya chikitsa key liye anushansit ayu seey cumm haye, tou doctor pareekshan karega kii kyaa avarodhan chikitsa rogi kii baadhit drishti kii bharpai curr sakati haye. rogi kii cumm seey cumm 4-5 saal kii umr taka shalya chikitsa mein deree kaa kaaran frontonsal aur oopari chehare key liye unake jatil vikas koo puuraa karane key liye deree kii aavashyakta haye. iss jatil vikas key puuraa honey key baad, doctor sthitiyon kaa adhik sateek maap praapt curr sakate hain. haalaanki, yadi rogi kii drishti baadha bigad jaati haye yaa avarodhan chikitsa key liye anuttardaayi saabit hoti haye tou jald hii shalya chikitsa kii aavashyakta hogi.
shalya chikitsa prakriyaon mein shamil hainh
frontliss sling sergery kewal tabhi kii jaa sakati haye jaba rogi kii tossis kii sthiti rogagrast yaa khinchai hui maanspeshiyon key kaaran hoe. maanspeshiyon kaa khinchaav umr key kaaran hotaa haye. frontliss sling sergery yaa tou prabhaavit maanspeshiyon koo kasane yaa chhota karane key liye kii jaati haye, jisase prakriya rogi key dhakkan kii aaraam karane kii sthiti koo badhaane mein madad karati haye. prakriya doctor key saath kii jaati haye jisamen samagri koo loop karane key liye sling kaa upayog kiya jaataa haye, phir ise rogi kii bhaunhon key neeche aur palakon key oopar dhaga kiya jaataa haye. ack baar goffen koo cuss lene key baad, yeh rogi key maathe kii maanspeshiyon koo dhakkan uthaane mein sahaayata kartaa haye. goffen koo panchbhuj yaa tribhuj (ekvachan yaa dohra) aakar mein ghumaaya jaa sakata haye. aaj bajar mein kaee sling mein monofilament nylon, silicon rodd, polyester, resham, collegen, steinless steel yaa polypropylene shamil hain.
frontliss sling sergery koo madhyam seey gambhir janmajaat tossis key liye sabse prabhaavi shalya chikitsa upchaar maanaa jaataa haye. shalya chikitsa key liye kaee alag-alag samagriyon kaa upayog kiya jaa sakata haye, halanki vartamaan mein yeh spasht naheen haye kii kiss samagri kii safalata darr sabse adhik haye.
levter vichhedan aur unnati shalya chikitsa parr kewal una rogiyon key liye vichaar kiya jaanaa chaahiye joe 5 mimi seey cumm yaa usake barabar levter kaary kaa anubhav curr rahey hain. levter function palak kii yatra kii doori koo maapata haye, joe frontliss maanspeshiyon koo sthanantarit kiye binaa neeche kii or seey oopar kii or kii or badhane key saath shuru hotaa haye. haalaanki iss prakriya koo dou alag-alag drishtikonon, aantarik aur baahari, key madhyam seey puuraa kiya jaa sakata haye, baahari drishtikon shalyachikitsakon koo prakriya key dauran shalya chikitsa sthal kaa behtar drishya praapt karane kii anumati detaa haye. shalya chikitsak palak parr cheere key saath shuruat karega. ack baar jaba levetor ujagar hoe jaataa haye, tou sarjan yaa tou ise modd detaa haye yaa ise tarsal plate mein silane seey pahale kaat detaa haye. iss prakriya key dauran, rogi kii palak kii oonchaai aur aakriti kaa nirnay rogi seey input key saath shalya chikitsak parr nirbhar kartaa haye.
whitenal sling prakriya koo levter seey whitenal ligament taka ack cheere key saath kiya jaataa haye. phir sarjan shwetkarn key snayubandhan koo behtar tarsal kinare seey jodkar silai karega. yeh prakriya sabse adhik sambhavana taba kii jaati haye jaba rogi cosmetic upasthiti key baare mein chintit houn. whitenall sling prakriya ack behtar cosmetic parinam pradaan karane mein saksham haye kyonki prakriya whitenall key ligament koo barkarar rakhane mein saksham haye. yeh lacrimal granthi aur asthaayi palak key samarthan koo banaae rakhane kii anumati detaa haye.
shalya chikitsa seey rogi koo joe laabh mill sakata haye, usake bavjood jokhim kaarak hain. shalya chikitsa key baad, rogi koo asmamit (asman) palakon kaa anubhav hoe sakata haye. yadi shalya chikitsa saavdhaanipoorvak naheen kii jaati haye, tou rogi koo sookhi aankho kaa anubhav hoe sakata haye kyonki aankh abb poori tarah seey bund naheen hoe rahee haye. shalya chikitsa key baad rogi koo raktasraav aur sankraman kaa anubhav bhee hoe sakata haye yadi shalya chikitsa sthal kii thheek seey dekhbhal naheen kii jaati haye. durlabh avsaron parr, rogi koo palakon kii gati mein kamee kaa anubhav hoga.
gair-shalya chikitsa vidhiyon jaise "crutch" chashme yaa tossis crutch yaa vishesh scleral contact lens kaa upayog palak koo sahaara dene key liye bhee kiya jaa sakata haye.
yadi bimari kaa safaltapurvak ilaaj kiya jaataa haye tou kissy bimari key kaaran honey vaale tossis mein sudhaar hoe sakata haye, halanki kuchh sambandhit roga, jaise kii occuloferringial muscular dystrophy, kaa vartamaan mein koee ilaaj naheen haye.
purvanuman.
yadi tossis kaa ilaaj naheen kiya jaataa haye, tou rogiyon koo aspashtata kaa anubhav hoe sakata haye, jise aalsi aankh key roop mein bhee jaanaa jaataa haye, joe rogi kii drishti koo sthaayi roop seey nuksan pahuncha sakata haye. visheshagyon seey saavdhaanipoorvak avalokan aur yojana banaane key baad, tossis kaa safaltapurvak ilaaj kiya jaa sakata haye. shalya chikitsa jaise upchaar seey rogi koo drishti mein sudhaar key saath-saath saundarya sambandhi parinam bhee milane lagenge. pahale tossis key liye ilaaj kiye gaye rogiyon key ack adhyayan mein, pahali sergery key 8 seey 10 varshon key bheetar aadhe koo atirikt sergery kii aavashyakta thee. yadi tossis pramukh swaasthya muddon (jaise cancer tumour yaa dardanaak chotein) seey sambandhit naheen haye, tou sthiti rogi kii jeevan pratyasha koo cumm naheen karegi.   
mahamari vigyaan.
tossis rogiyon parr kiye gaye netra vigyaan adhyayanon key anusaar, ghatana darr iss prakaar haye. aponeurotic tossis kaa anubhav karane vaali mahilaaon kii ausat ayu 67.83 varsh haye, aur sambandhit purush ausat ayu 68.19 haye. janmajaat tossis key liye ausat ayu mahilaaon key liye 12.27 varsh aur purushon key liye 8.57 varsh haye. mechanical tossis key liye ausat ayu mahilaaon mein 49.41 varsh aur purushon mein 43.30 varsh haye. myogenic tossis key liye ausat ayu mahilaaon key liye 53.45 aur purushon key liye 43.30 haye. neurogenic tossis key liye ausat ayu mahilaaon mein 43.6 varsh aur purushon mein 32.62 varsh haye. anta mein, aaghaatjanak tossis key liye ausat ayu mahilaaon mein 35.12 varsh aur purushon mein 33.4 varsh haye. tossis mein koee samagr ling yaa nasleeya vareeyata naheen paaee gaee thee.
shodh dishaaen.
vartamaan adhyayanon ney sanket diyaa haye kii pichhale tareeke, jaise kii occlusion therapy aur sergery, iss sthiti key ilaaj key liye sabse upayukt maane jaate hain. aage key adhyayanon koo ishtatam shalya chikitsa sanketon koo nirdhaarit karane mein saksham honey key liye protsaahit kiya jaataa haye. sookhi aankh key saath drishtikon parr koee bhee khoj occuloplastic sergery koo aage badhaane mein madad karegi.
vyutpatti.
tossis yunani shabd πτνσις ("ptōsis", "Fall") seey liya gayaa haye, aur ise "kissy anga yaa shareer key hisse key asamanya cumm honey yaa failane key roop mein paribhaashit kiya gayaa haye."