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Blepharochalasis

Blepharochalasis is a quite rare disorder that affects the upper eyelids – they become inflamed and then swell up for several days at a time.

The distinguishing feature of the disorder compared to other disorders showing the same symptoms is the recurrent nature of it. It just comes and goes in an irregular fashion, and as time goes on the repeated episodes take their toll and give rise to the serious further symptoms of eyelids becoming permanently swollen with fluid.

Eventually the skin of the eyelid or eyelids – since it usually affects both – stretches and the underlying tissue is allowed to waste away, or “atrophy”.

Blepharochalasis needs to be differentiated from Dermatochalasis, which is a fairly common condition affecting the elderly.  Dermatochalasis occurs due to skin laxity as we age and is easily corrected by a blepharoplasty, which is discussed later on this post.

What causes Blepharochalasis?

Nobody seems to know.

However it’s thought that it might be related in some way to instances of allergic reaction, congenital heart disease (so family history is important) or following on from bouts of emotional or physical stress.

It seems to occur predominantly in the 10 to 20 year old age group.  After that age the disorder may settle down with very few if any episodes.

Symptoms

There are two basic stages in the development:

•    Stage 1 – sometimes called the “active” stage, it doesn’t involve pain fortunately, merely recurring swelling of the eyelids

•    Stage 2 – this involves the skin of the eyelids “thinning out” as it is repeatedly stretched by the swellings. This stage is often called the “quiescent” or “dormant” stage by ophthalmologists, in which the underlying tissue in the eyelids is atrophied or wastes away.

As well as stages 1 and 2 there are some complications that occasionally occur:

Entropion – where the lower eyelid turns upward and inward in such a way that the eyelashes touch the eye surface. Constant abrasion from the strong eyelashes can cause corneal ulcers

Ectropion – this occurs when the lower eyelid this time sags outward and downward. This can lead to the eye drying out and yet again development of corneal ulcers

Conjunctival hyperaemia – alternative spelling hyperemia – is the term used to describe the condition of the blood vessels on the inner side layer of the eyelids that cover the sclera (the white part of the eye) becoming engorged.

Treatment Options

There is little or no treatment available through drugs in eye drops or topical ointment form. The only real treatment options are covered by surgical procedures.

Surgical procedures are only carried out once the disorder has maintained an inactive period of at least six months or has obviously run its course – it’s pointless operating otherwise or the procedure needs to be repeated.

The procedures, involving as they do the way a patient is going to appear at the end of the day, are sometimes carried out by a plastic surgeon instead of an ophthalmologist:

•    A blepharoplasty procedure involves removing excess skin and atrophied internal tissue. Occasionally associated eye muscles and tendons need attention.

•    Replacing atrophied tissue with fat grafts

•    Introducing a tuck as in conventional plastic surgery

•    Operating on the canthus, the point at which the eyelids meet (at the side of the nose)

What are the outcomes?

As adolescents grow into their twenties the time period between intermittent swelling episodes lengthens, and it’s possible that some self regulation happens.

Future research is focussed on immunological and genetic factors.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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