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Neurogenic causes include benign essential blepharospasm and hemifacial spasm (unilateral spasm of the upper and lower eyelids). In the normal eye, MRD-1 is typically 45mm, and a decrease in this measure signals the presence of ptosis [5, 11, 16]. A thorough examination for pseudoretraction is therefore essential in cases of unilateral ptosis that are candidates for surgery. Blepharoptosis also referred to as ptosis, is a medical condition in which the upper eyelids descend abnormally across the cornea, creating a tired or droopy eye look. National Library of Medicine They use a vision eye chart test to see how your droopy eyelids affect your vision. The prevalence and wide-ranging clinical and functional implications of acquired ptosis make timely and accurate diagnosis and treatment important for eye care practitioners. Post the Definition of blepharoptosis to Facebook, Share the Definition of blepharoptosis on Twitter, Palter, Dissemble, and Other Words for Lying, Skunk, Bayou, and Other Words with Native American Origins, Words For Things You Didn't Know Have Names, Vol. It is often divided into two main types: congenital and acquired. Congenital ptosis (present at birth) typically has a unilateral presentation and is most often a result of developmental myopathy of the levator muscle that affects the levators ability to contract and raise the upper eyelid [2022]. Epub 2011 Jan 28. These mechanical interventions are, at best, temporary solutions that may present more inconvenience to patients than benefit. Blepharoptosis, commonly known as ptosis (droopy eyelids), is the term used to describe the drooping of one or both eyelids. Wong SH, Plant GT. Surgery to remove excess eyelid tissue (blepharoplasty) may also be performed. Adrenergic receptors in the ptotic human eyelid: correlation with phenylephrine testing and surgical success in ptosis repair. The problem is also called ptosis. 1. Side effects of treatment in adults include muscular weakness, neck pain, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, congenital fibrosis of the extraocular muscles, A Modified Surgical Technique Using Levator Aponeurosis-Muller Muscle Complex to Correct Mild-to-Moderate Blepharoptosis, Synchronous Surgical Treatment of Lower Eyelid Involutional Entropion and Ptosis, Efficacy of brow suspension with autogenous fascia lata in simple congenital ptosis, Vision Improvement with Refractive Correction Does Not Completely Exclude Major Eye Diseases: Analyses of Visually Impaired South Korean Population in the Korea National Health and Nutrition Examination Survey 2009-2011, A case report of psychoactive drugs aggravating and alleviating Meige syndrome, Frontalis Muscle Flap Suspension Surgery for the Treatment of Blepharoptosis Based on the Anatomical Study of the Frontal Muscle Nerve in the Third of the Eyebrow/ Cirugia de Suspension del Colgajo Muscular Frontal en el Tratamiento de Blefaroptosis Basado en el Estudio Anatomico del Nervio del Musculo Occipitofrontal en el Tercio de la Ceja, Frontalis sling surgery: silicon rod versus autogenous fascia lata in congenital ptosis, Update on intra-arterial chemotherapy for retinoblastoma, PTOSIS -TYPES AND OPERATIONS FOR CORRECTION, Lower cholesterol safely: nutritional interventions for healthy lipids, Botox treatment for migraine and chronic daily headache in adolescents, Blepharophimosis Ptosis Epicanthus Inversus, blepharophimosis, epicanthus inversus, and ptosis 3, Blepharophimosis, Ptosis, and Epicanthus Inversus Syndrome, Blepharophimosis-Ptosis-Epicanthus Inversus-Telecanthus. Outcomes of anterior levator resection in congenital blepharoptosis. Severity of visual field loss and health-related quality of life. With contraction, Mllers muscle helps to sustain upper eyelid elevation provided by the levator, while also supplying 12mm of additional lift [5, 14]. Similarly, in the Fasanella-Servat procedure, the lower part of Mllers muscle, overlying conjunctiva, and upper border of the tarsus are resected. Godfrey KJ, Korn BS, Kikkawa DO. Effect of 0.5% apraclonidine on ptosis in Horner syndrome. Delivered to your inbox! Mud runs: Dirty, challenging, next-level fun, Wildfires: How to cope when smoke affects air quality and health. Dacryocystorhinostomy. These underlying conditions can also be emergent and potentially life-threatening, and therefore require rapid intervention. The oxygenated hemoglobin ( oxyhemoglobin) makes the blood in arterioles (and arteries) look bright red. Studies also show that improvements in subjective and objective visual performance following intervention are associated with improved HRQoL-related measures [12, 13]. A detailed history and exam are crucial in the evaluation of a patient presenting Despite these well-established benefits of surgery, however, it is not an ideal approach for some patients. The effect of ptosis goes beyond diminished performance on visual field tests. government site. Less relevant in the context of acquired ptosis is MRD-2 (the distance from the centre of the pupillary light reflex to the lower eyelid margin with the eye in primary gaze) and MRD-3 (the distance from the pupillary light reflex to the upper eyelid margin with the eye in extreme upgaze). The serious neurological or muscular conditions most commonly encountered in clinical practice include Horners syndrome, 3rd cranial (oculomotor) nerve palsy, myasthenia gravis, and CPEO. Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. In the context of treating ptosis, this side effect profile is likely undesirable to patients and practitioners. Mechanical causes include dermatochalasis (excessive upper eyelid skin that overhangs the lid margin), brow ptosis (drooping of the eyebrow), and floppy eyelid syndrome (easy eversion of the upper eyelid due to excessive lid laxity). Go To Source: Orphanet Classification Categories: The edge of the upper eyelid may be lower than it should be (ptosis) or there may be excess baggy skin in the upper eyelid (dermatochalasis). Blepharoptosis: an abnormal, low-lying upper eyelid margin. This drooping can affect one or both eyes, and based on time of appearance, it is broadly classified as either congenital (present at or shortly following birth) or acquired (appearing later in life). Naphazoline use has also been reported in ptotic patients with myasthenia gravis, with topical use providing observable opening of the eye in 70% of enroled patients [74]. Studies reporting on the prevalence of ptosis in the general adult population. A retrospective analysis of 35 patients aged 1850 years old presenting with ptosis in a hospital ophthalmology department found that 29 of the 35 patients had a history of either hard or soft contact wear (mean wear time 17.6 and 9 years, respectively) [26]. Normally, the upper eyelid covers about 1 to 2 millimeters of the cornea. English Dictionary Sentences Grammar Definition of 'blepharoptosis' blepharoptosis noun prolapse or drooping of the upper eyelid Collins English Dictionary. 2023 by The President and Fellows of Harvard College, Do not sell my personal information | Privacy Policy. Inclusion in an NLM database does not imply endorsement of, or agreement with, The normal adult upper lid lies 1. Satariano N, Brown MS, Zwiebel S, Guyuron B. Older JJ. Eyelid drooping Eyelid drooping is excess sagging of the upper eyelid. Stay on top of latest health news from Harvard Medical School. A hot weather plan is essential to staying healthy, Young men with prostate cancer: Socioeconomic factors affect lifespan, Talking to your doctor about your LGBTQ+ sex life, Play helps children practice key skills and build their strengths, Harvard Health Ad Watch: An IV treatment for thyroid eye disease. JAMA Ophthalmol. It can affect one or both eyes. Support for manuscript preparation (see Acknowledgements) was provided by RVL Pharmaceuticals, Inc., an affiliate of Osmotica Pharmaceuticals plc. Artifcial opening beteween the tear,and nose. Amblyopia Amblyopia is the loss of the ability to see clearly through one eye. Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis. Distribution of adrenergic receptor subtypes and responses to topical 0.5% apraclonidine in patients with blepharoptosis. A prospective study enroling 26 patients scheduled for ptosis surgery revealed variability in upper eyelid responsiveness to apraclonidine 0.5%, and immunohistochemical examination of resected Mllers muscle tissue revealed higher expression of the 1D-adrenergic receptor subtype in responsive eyelids, suggesting that the drugs effect on the upper eyelid is mediated at least in part by agonism of 1D receptors [18]. News & The frontalis muscle, which inserts at the level of the eyebrows, is innervated by the facial nerve (cranial nerve VII) and its contraction raises the brow, with no direct effect on upper eyelid elevation. Drooping eyelids may occur on both sides (bilateral) or on one side only (unilateral), in which case it is more easily noticed. In this study, the median age among patients with aponeurotic ptosis was 62 years. From Frazier et al., 2000. Patient examination is important to distinguish these from other more infrequent types of ptosis, such as those neurogenic, myogenic and posttraumatic. Lim JM, Hou JH, Singa RM, Aakalu VK, Setabutr P. Relative incidence of blepharoptosis subtypes in an oculoplastics practice at a tertiary care center. Drooping of the upper eyelid causing a narrowing of the palpebral aperture. A retrospective analysis of 1519 patients who underwent ptosis surgery revealed that revision was required in 8.7% of cases, with a 6.8% revision rate in patients who underwent a posterior-approach procedure and a 9.5% revision rate in those who underwent an anterior-approach procedure [62]. In this condition, the border of the upper eyelid falls to a lower position than normal. A decrease in palpebral fissure height can be an indicator of disinsertion of the levator aponeurosis from the tarsal plate [16, 44]. A positive response to phenylephrine (eyelid elevation) is indicative of Mllers muscle function and suggests that the patient is a candidate for Mllers muscle-conjunctival resection [16, 4448]. Garibaldi DC, Hindman HB, Grant MP, Iliff NT, Merbs SL. We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Dermatochalasis, the presence of redundant upper eyelid skin, is identified by lifting the excess eyelid skin and performing an eyelid examination. As noted in Acquired ptosis overview, prevalence, and impacts above, patients who undergo ptosis surgery report improved ability to perform common visual tasks and activities of daily living, leading to an improved functional index [12, 13, 49]. Controversies and advances in the management of congenital ptosis. Evaluating the visual field effects of blepharoptosis using automated static perimetry. Ptosis following ocular surgery can be transient or persistent. If levator function is poor, the desired upper eyelid elevation can be provided via Whitnalls ligament suspension, in which aponeurotic resection is followed by suturing of Whitnalls ligament to the tarsal plate and suspension of the ligament to the periosteum of the superior orbital rim [44, 60]. Slonim CB, Foster S, Jaros M, Kannarr SR, Korenfeld MS, Smyth-Medina R, et al. In an analysis of 251 patients referred for ptosis surgery to an ophthalmic surgery centre in Singapore, aponeurotic ptosis was the most common form of ptosis observed (60.2%). Another study, of 17,296 patients 40 years old in Korea, reported an overall prevalence of ptosis of 13.4%, with the lowest prevalence (5.4%) among patients 4049 years old and the highest prevalence (32.8%) among patients 70 years old [3]. Blepharoptosis may be barely noticeable or quite prominent. A case report also revealed elevation of the upper eyelid in three patients with Horners syndrome after instillation of 0.5% apraclonidine [67]. Patients reported levels of appearance-related distress, anxiety, and depression that were higher than typical norms in the general population and similar to levels previously reported in patients with other appearance-altering ophthalmic conditions, such as strabismus [8]. Medical Policy Bulletin Number 0084. Literature cited in this review was identified via a broad search of the PUBMED online database for English-language, peer-reviewed publications including search terms such as ptosis, epidemiology, etiology, eyelid, surgical, pharmacologic, Mllers muscle, adrenergic, visual field, and quality of life. Relevant primary and review articles were reviewed and cited when providing unique primary data or a current summary of fundamental concepts. The site is secure. Whitnalls sling for poor function ptosis. Levator aponeurosis surgery for the correction of acquired ptosis. In a study in the United Kingdom, adults referred for ptosis surgery were assessed prior to surgery using validated questionnaires addressing psychosocial factors, including appearance-related distress (the Derriford Appearance Scale (DAS 24)), anxiety and depression (the Hospital Anxiety and Depression Scale (HADS)), fearful or worrying conditions related to the perceived opinions of others (the Fear of Negative Evaluation (FNE) Scale), and self-evaluation of appearance (the Centre for Appearance Research Valence (CARVAL) scale). What Are the Best PsA Treatments for You? Another known cause of ptosis is ocular surgery. As ophthalmological conditions go, blepharoptosis is not very severe. Comparison of automated and manual perimetry in patients with blepharoptosis. It is characterised not only by mild unilateral ptosis of the upper eyelid, but also the lower eyelid (i.e., slight elevation of the lower lid margin), ipsilateral pupillary miosis, facial anhidrosis, and a positive pupillary response (dilation) to topical phenylephrine (which can be used to differentiate between pre- and post-ganglionic Horners syndrome) or apraclonidine [5, 16, 39, 40]. Non-surgical approaches to managing ptosisand clinical evidence supporting any of these approacheshave been comparatively limited (Table4). It is also called "lazy eye." The centre of fixation on the LPFT is shifted 15 inferiorly to maximise testing of the superior field, enable more natural eyelid positioning, and prevent compensatory behaviours, such as brow elevation [10]. A case study in a single patient with anterior laminectomy-induced Horners syndrome revealed a positive effect of twice-daily unilateral administration of brimonidine tartrate 0.1% for 3 months [75]. Pullum KW, Whiting MA, Buckley RJ. Furthermore, the Korean study found an association between higher body mass index (BMI), as well as a history of cardiovascular disease, and the presence of ptosis [3]. Brow ptosis (3.1% incidence) was the most commonly reported adverse event in the upper face, followed by eye sensory disorders (3.0%), and eyelid ptosis (2.5%), with all events being transient and resolving spontaneously [36]. In this condition, the border of the upper eyelid falls to a lower position than normal. More recently, the efficacy and safety of an oxymetazoline 0.1% ophthalmic solution approved for the treatment of acquired ptosis (UpneeqTM, RVL Pharmaceuticals, Inc., Bridgewater, NJ, USA) has been reported. Ophthalmology. Ptosis can also be secondary to a range of underlying neurological or muscular conditions, including 3rd cranial nerve palsy, CPEO, oculopharyngeal muscular dystrophy, Horners syndrome, and myasthenia gravis [5, 16]. It also has attachments to the skin of the upper eyelid, which contribute to the formation of the lid crease. Topical naphazoline in the treatment of myasthenic blepharoptosis. Neurogenic forms of congenital ptosis can be caused by cranial nerve III abnormalities or insufficient sympathetic innervation of Mllers muscle. Sign up now and get a FREE copy of theBest Diets for Cognitive Fitness. 1North Bay Eye Associates, Petaluma, CA USA, 2Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL USA, 3Department of Ophthalmology and Visual Neurosciences, Department of Otolaryngology, University of Minnesota, Minneapolis, MN USA, 4Massachusetts College of Pharmacy and Health Sciences, Worcester, MA USA. Thean JHJ, McNab AA. Examination should include palpation of the superolateral portion of the upper eyelid beneath the tail of the brow near the orbital rim, and if a mass is suspected, referral to a specialist is recommended. The pathology specific to the various forms of pseudoptosis means that treatment targeting the upper eyelid muscles or aponeurosis is unlikely to resolve the condition, so when conducting the upper eyelid exam, it is important to identify any causes of pseudoptosis. If onset suggests serious underlying condition (e.g., Horners syndrome, 3rd cranial nerve palsy, myasthenia gravis, CPEO), examine for characteristic ophthalmic or non-ophthalmic signs and perform appropriate ancillary testing (e.g., phenylephrine or apraclonidine test for Horners syndrome, rest test/ice test, anti-acetylcholine antibody testing for myasthenia gravis) [5, 15, 16, 40], Evaluate periocular skin and soft tissues to identify/exclude mechanical cause or tumour [5, 16, 22], If dermatochalasis or brow ptosis present, examine upper eyelid while raising excess skin [16], Examine the globe for dystopias (enophthalmos, hyper/hypoglobus) or asymmetry (phthisis bulbi, microphthalmia) [16], If contralateral retraction is suspected, examine for thyroid eye disease [16], Modified Humphrey Visual Field Test; automated, operator-independent, static perimetry test evaluating a 48 superior field, using a 35-point grid (14-point grid in inferior field used as reference) [10], Shifted centre of fixation allows for more natural eyelid positioning and reduction of compensatory behaviours. Blepharoptosis, also referred to as ptosis, is defined as an abnormal low-lying upper eyelid margin with the eye in primary gaze. You can develop blepharoptosis if you receive an injury to your head or eye that damages the levator muscles, which hold up your eyelids. Mokhtarzadeh A, Harrison AR. Custer PL Blepharoptosis. ____ 26. When present at birth, it is called congenital blepharoptosis, and is usually caused by poor development or weakness of the levator muscle that lifts the eyelid. Ptosis Sometimes ptosis is an isolated problem that changes a person's appearance without affecting vision or health. Causes Amblyopia occurs when the nerve pathway from one eye to the brain does not develop during childhood. Lee GN, Lin LW, Mehta S, Freitag SK. Elevation of the upper eyelid is largely provided by two musclesthe levator palpebrae superioris (levator) and the superior tarsal (Mllers) muscle (Fig. JB reports speaker fees from Aerie Pharmaceuticals, Alcon, Allergan, Bausch & Lomb, Glaukos, New World Medical, and Sun Pharmaceutical Industries, Inc.; consultant fees from Aerie Pharmaceuticals, Alcon, Allergan, Bausch & Lomb, Injectsense, New World Medical, Optovue, and Osmotica Pharmaceuticals; personal fees from Sun Pharmaceutical Industries, Inc.; and research support from Aerie Pharmaceuticals, Allergan, Novartis, Glaukos, Optovue, and Ocular Therapeutix. A lacrimal gland mass can present as upper eyelid ptosis, and potential aetiologies for lacrimal gland masses include lymphoma, adenoid cystic carcinoma, or pleomorphic adenoma, all of which require workup prior to considering ptosis as the diagnosis. Maheshwari R, Maheshwari S. Mullers muscle resection for ptosis and relationship with levator and Mullers muscle function. As your body ages, the muscles around your eyes weaken, causing your eyelids to droop and sag. National Library of Medicine Our ophthalmology team offers the most advanced treatments for all types of eye conditions. Ptosis can usually be corrected surgically. Ptosis can affect one or both eyes. Blepharoptosis. Merriam-Webster.com Medical Dictionary, Merriam-Webster, https://www.merriam-webster.com/medical/blepharoptosis. A larger evaluation of the effect of apraclonidine on upper eyelid elevation was conducted in 100 non-ptotic subjects, demonstrating small mean increases in MRD-1 at 30 and 45min post-instillation that were hypothesised to be a result of stimulation of postsynaptic 1-adrenergic receptors [68]. Pseudoptosis can arise, for example, due to a range of mechanical (dermatochalasis, brow ptosis, floppy eyelid syndrome), anatomical (globe dystopias, globe asymmetry, ocular misalignment), or neurogenic (hemifacial spasm, blepharospasm) causes, or contralateral eyelid retraction (thyroid eye disease) [5, 16, 40]. Reports of ptosis incidence in surgical populations are consistent with those in broader patient populations. Finally, acquired ptosis can arise due to trauma to the eyelid retractor muscles, aponeurosis, or neural inputs to the eyelid. 8600 Rockville Pike While bilateral moderate/severe visual field loss was associated with the greatest negative effect on HRQoL measures, decreases in HRQoL were also evident in participants with mild unilateral visual field loss [7]. Although there are many types of ptosis, the two most frequent clinical cases are simple congenital ptosis in young patients and senile ptosis in adults. Meyer DR, Stern JH, Jarvis JM, Lininger LL. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. PLUS, the latest news on medical advances and breakthroughs from Harvard Medical School experts. Furthermore, the expansion of therapeutic options may help to improve the patient focus of treatment, by allowing for the use of surgical and non-surgical approaches as appropriate based on underlying ptosis aetiology, severity, and patient preference. Ptosis, also referred to as blepharoptosis, is defined as an abnormal low-lying upper eyelid margin with the eye in primary gaze. Cf Electronic fluorography, Hysterosalpingography. Loeffler M, Solomon LD, Renaud M. Postcataract extraction ptosis: effect of the bridle suture. (ptosis) The drooping or downward displacement of a body part. Blepharoptosis, or ptosis of the eyelid, refers to drooping of the upper eyelid that usually results from a congenital or acquired abnormality of the muscles that elevate the eyelid. Topical naphazoline was also reported to improve upper eyelid elevation in a cohort of 12 patients with myopathic ptosis, with limited ocular side effects, but tachyphylaxis was observed with frequent daily dosing over a period of weeks [73]. To continue reading this article, you must log in. Clinical evaluation of blepharoptosis: distinguishing age-related ptosis from masquerade conditions. McKean-Cowdin R, Varma R, Wu J, Hays RD, Azen SP, Los Angeles Latino Eye Study Group. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. A controlled, randomized, multicenter clinical trial. Battu VK, Meyer DR, Wobig JL. Topical sympathomimetic agents, including phenylephrine, apraclonidine, brimonidine, and naphazoline, have ophthalmic applications outside of ptosis, but have also been evaluated for their effects on the ptotic upper eyelid based on their potential to activate Mllers muscle, which has been shown to express the 1/1D, 2A, and 2C adrenergic receptor subtypes [1719]. Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery. 2017 Mar-Apr;33(2):439-442. doi: 10.12669/pjms.332.11521. Consistent with these individual studies, a systematic literature review found significant risk associated with both hard (odds ratio 17.38 (3.7181.29)) and soft (odds ratio 8.12 (2.6824.87)) contact lens wear [27]. Try looking up a doctor, a clinic location, or information about a condition/treatment. After appropriate examination of the ocular and periocular structures, assessment of upper eyelid function can be performed with a few simple measurements. Federici TJ, Meyer DR, Lininger LL. Mendona TB, Lummertz AP, Bocaccio FJ, Procianoy F. Effect of low-concentration, nonmydriatic selective alpha-adrenergic agonist eyedrops on upper eyelid position. Broadly, ptosis is classified based on time of onset. While suggestive of possible applications in treating some cases of ptosis, the data regarding the adrenergic agents phenylephrine, apraclonidine, brimonidine, and naphazoline are limited in scope and none of these agents are approved for the treatment of ptosis. Hooded eyelids are where excess skin folds down from the brow line. Pauly M, Sruthi R. Ptosis: evaluation and management. In adults blepharoptosis is usually caused by aging, eye surgery, or disease affecting the levator muscle or its nerve. Patients should be examined for suspicious lesions, such as basal cell or squamous cell carcinoma of the skin, or unusual masses beneath the skin. Levator aponeurosis surgery. the contents by NLM or the National Institutes of Health. A retrospective study of patients with dehiscence of the levator aponeurosis found that 78% of eyes instilled with a single drop of 10% phenylephrine showed a positive response (i.e., an increase in MRD-1), and that responsiveness did not depend on ptosis severity or levator function. The levator is innervated by the superior division of the oculomotor nerve (cranial nerve III), and its contraction provides the majority (~80%) of upper eyelid elevation [5, 1416]. Hosten LO, Snyder C. Over-the-counter ocular decongestants in the United States - mechanisms of action and clinical utility for management of ocular redness. Acquired ptosis is most often due to age-related changes in the upper eyelid retractor muscles [24, 25], but underlying causes are varied, and many practices and interventions common in eye care today, such as contact lens wear and cataract and glaucoma procedures, can in fact contribute to the development of transient or more persistent forms of ptosis [2535]. There are several types of surgery your doctor might consider, including: While all of these surgeries are slightly different, they all work to correct the drooping of the eyelid and return your vision to normal. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, andmore. Ptosis may be the presenting sign or symptom of serious neurologic disease. The reduction in HRQoL was found to be, at least in part, due to the reduction in independence (greater difficulty driving and performing regular tasks) that arises due to visual field deficits [7]. apparent ptosis. Ophthalmic Plast Reconstr Surg. Evaluation of the globe can identify dystopias such as enophthalmos, hyperglobus, hypoglobus, or asymmetry caused by phthisis bulbi, microphthalmia, or other conditions affecting globe size and giving the appearance of unilateral ptosis [16]. Causes A more recent study of >4700 Iranian patients 45 to 69 years old reported an incidence of 4.7%, with the lowest prevalence (3.1%) among patients aged 4549 years and the highest prevalence (7.1%) among patients aged 6064 years [2]. Glatt HJ, Fett DR, Putterman AM. Studies reveal that this can have important impacts on patient well-being, including reduced independence and increased appearance-related anxiety and depression [7, 8].

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