Blepharochalasis

Introduction

Blepharochalasis is a condition that affects the eyelids as they lose their natural elasticity in the aging process. Fluids can build up in the tissues of the lower lids and cause them to sag, and the upper lids to droop, sometimes to the extent that they may cover part of the visual axis, or line of sight. However, it is also seen in younger people, typically during puberty or who are in their early 20s.

In figure 1, we see a typical appearance of blepharochalasis; note especially how the upper lids have begun to cover the upper pupils of each eye. When the visual field is compromised, as it would be in this patient, surgery to correct the problem would be considered medically necessary and not cosmetic.)

Pronounced “Bleff-ah-roh-shah-lay-sis,” this condition in younger people may be due to a genetic issue or an internal condition; some suspected triggers include kidney and vertebral abnormalities, although neither of these has been shown conclusively to be at fault. It can affect only one eye or both.

Symptoms

In older people, the process is gradual and is usually benign, unless the upper lids cover the line of sight. In younger patients, the eyelids go through periods of swelling and deflation, each bout lasting a few days. Blepharochalasis can also cause entropion, where the eyelids turn inward or where the eyelashes then scratch the surface of the eye and cause scratching and irritation. Another possible effect is the sagging of the lower lid away from the globe, known as ectropion that can cause problems with drainage of the tears, which then spill over and irritate the skin. Ptosis, the medical term for drooping eyelids, also causes a cosmetic problem.

Treatment

Even in the absence of ptosis, eyelid skin repair is a priority, particularly in young people, but also for older patients. The most common type of surgery is called blepharoplasty, also called a “lid lift,” where small incisions are made along the natural wrinkle or crease lines and excess skin and fatty tissue are removed. The result is a tighter, more elevated eyelid.

For short term help, cold compresses over the eyelids help reduce swelling and inflammation. In more severe cases, oral anti-inflammatory medications may be prescribed in addition.

(Figure 2 shows a schematic of blepharoplasty, the surgery to remove excessive fat deposits from the skin surrounding the eye.)

When the eyelids droop over the line of sight, simple tests in the eyecare practitioner’s office will confirm this. Most medical insurance plans will generally cover the blepharoplasty to correct it, as the surgical procedure is then judged to be medically necessary and not just cosmetic surgery.

Summary

If you experience any eyelid problem, see your eyecare practitioner right away. While blepharochalasis is not necessarily an urgent matter unless the lashes are scratching the eye, it should still be evaluated to rule out other possible lid conditions.