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R P Sharma
L-5, Shastri Nagar, Meerut (U.P)-250 004
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Sharma R P, Singh S P, Mithal S. Blepharochalasis. Indian J Dermatol Venereol Leprol 2002;68:231
AbstractA-16-year old female with laxity, atrophy, wrinkling and telangiectases of skin of both upper eyelids is being reported. These changes were preceded by recurrent, painless edema of eye lids, starting at the age of 14 years.
Blepharochalasis-like illness was first described by Beer in 1817, later on Fuchs in 1896 gave its present name. It typically affects the upper eyelids bilaterally but may be unilateral and may affect lower lids also. This condition is uncommon and develops usually insidiously around the time of puberty. In this condition after recurrent attacks of lid edema, skin becomes atropic, wrinkled, redundant and discoloured. There may be multiple telangiectases. The eyelid swelling is painless. The aetiology is obscure. Histopathology of lesional skin shows mild dermal lymphocytic infiltrate in early stage and decreased, fragmented elastic tissues in later stages. A recent case report described IgA deposition in residual elastic fibres implying that an autoimmune mechanism may be involved.
A 16-year-old female attending outpatient department complained of progressive wrinkling of skin of both upper eye lids since last 4 months. She also gave the history of recurrent episodes of painless swelling of both upper eyelids since last 2 years at an interval of approximately 3-4 months. Initially, eyelid swelling developed one week after minor head injury and lasted for about 7-10 days. The same illness recurred at an interval of 3-4 months, and subsided of its own. On examination the skin of both upper eyelids was atropic, wrinkled and redundant. Thin blood vessels were visible over lateral parts of lid skin. There was visible over lateral parts of lid skin. There was no ptosis or laxity of skin any where else on the body. The upper lip and thyroid were normal. There was no other associated illness. Systematic examination and routine investigations were within normal limits. Patient denied consent for biopsy. She was diagnosed as a typical case of bhepharochalasis on clinical grounds.
Most cases are sporadic but some pedigrees show autosomal dominant inheritance. Blepharochalasis is occasionally manifestation of generalised cutis laxa or it may form a part of Ascher′s syndrome. In our patient upper lip and thyroid were normal which are enlarged in Ascher′s syndrome. There was no laxity of skin on other body parts as seen in cut′s laxa. It should be differentiated from dermatochalasis found in older persons with baggy eyelids due to senile atrophy of the Skin. Many patients develop blepharochalasis after an emotional and physically traumatic event. Our patient also had history of head injury one week prior to developing first attack of lid swelling. The only treatment is surgical correction. It should be delayed till the disease is quiescent as the treatment may fail because of the attack of lid edema in the post-operative period.
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