Blepharochalasis: Description, Causes and Risk Factors:Blepharochalasis is an uncommon disorder characterized by recurrent, non-painful, non-erythematous episodes of eyelid edema. It must be distinguished from dermatochalasis, which is an involutional change of eyelids and is associated with loose, redundant skin. It has been divided into hypertrophic and atrophic forms. In the hypertrophic form recurrent edema results in orbital fat herniation through a weakened orbital septum. Most patients who have blepharochalasis present in an atrophic condition with atrophy of redundant eyelid skin and superior nasal fat pads. Most of these atrophic patients do not go through a hypertrophic phase.Blepharochalasis usually affects the upper eyelids bilaterally but may be unilateral and may affect lower lids. The condition is uncommon and frequently develops insidiously around the time of puberty. Many cases are sporadic but some pedigrees show autosomal dominant inheritance. In this condition, after recurrent attacks of lid edema, the skin becomes atrophic, wrinkled, redundant and discolored. There may be multiple telangiectases. The eyelid swelling is painless. The etiology is obscure. Histopathology of lesional skin shows mild dermal lymphocytic infiltrate in the early stage and decreased, fragmented elastic fibers in later stages. Deposition of IgA in residual elastic fibers can be present, implying that an autoimmune mechanism may be involved.Patients usually develop blepharochalasis when they are young, typically under the age of 30. This distinguishes it from dermatochalasis, the drooping of the upper eyelids that occur with age. Patients with dermatochalasis also tend not to develop the distinctive thinned, wrinkly tissue seen in cases of blepharochalasis. The names for both conditions include the Greek root for "relaxation," describing the signature sign of both conditions, a relaxation of the muscles that normally support the eyelids.For the most part, blepharochalasis is not a dangerous condition. It is primarily an aesthetic concern, as the eyelid looks unusual and may attract attention. Patients who develop droopy eyelids can experience vision impairments, and sometimes more rare complications develop. It is advisable to see an ophthalmologist to screen for potentially dangerous complications and to get advice on managing the inflammation. If surgery is necessary or desired, the ophthalmologist can make a referral to an Oculoplastic specialist.Symptoms:The usual symptom is repetitive and painless swelling of eyelids.The swelling (edema) usually involves only the upper eyelid of both the eyes. The swelling usually remains for few days and subsides on its own. Swelling may recur after a variable duration of time. Physical or emotional stress may result in repeated episodes of swelling.Repeated episodes of swelling make the skin over the eyelid very thin, as much as the inner colored portion of the eye may be visible through the eyelid skin, sometimes. Cigarette paper like fine wrinkles may be present. The vessels passing through skin of the eyelid may seem dilated. The color of the skin of the eyelid may change due to pigment deposition. Eventually, the skin overlying the eyelid may be stretched and become non-functional. The eyelids may close while standing due to the effect of gravity. This causes vision problems.Diagnosis:Multiple attacks of eyelid edema result in thinning, stretching, and atrophy of eyelid tissues. Theeyelid skin becomes redundant, discolored, andatrophic, appearing like wrinkled cigarette paper.The upper eyelids are more commonly affected, butthe lower eyelids may also be involved. Laxity ofthe lateral canthal tendon results in rounding ofthe lateral canthal angle and blepharophimosis.Dehiscence and thinning of the levator aponeurosisresults in blepharoptosis associated with excellentlevator palpebrae superioris function.Pseudoepicanthal folds are formed by atrophy of thesuperior nasal fat pads. Numerous cases of blepharochalasis have been reported.CT Scans: CT scan can be performed to confirm the presence of the syndrome. Multiple images of the affected eye are taken from different angles and rendered to a computer. This helps form an absolute image of the eyes of the patient. The tests help determine any damage caused to the eyelids. Such clinical tests help rule out medical conditions like idiopathic orbital inflammation or thyroid orbitopathy which may give rise to eyelid edema.Treatment:The treatment for these patients is blepharoplasty. Blepharoplasty involves removal of the pseudoherniated fat pad that protrudes through a weakened orbital septum. This can be accomplished through the transcutaneous or transconjunctival route. The most common approach is the transcutaneous lower eyelid blepharoplasty. The advantage of this approach is that it corrects excess skin and muscle laxity; the disadvantage is increased risk of lower lid retraction. Surgery should be delayed till the disease is quiescent, because the treatment may fail and because postoperative eyelid edema may occur.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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