Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Report
2001:67:4;216-217
PMID: 17664751

Blepharochalasis

Anil Kumar1 , GA Surwade2 , US Khaire2 , Reshakiran Shende2
1 Department of Medicine, Government Medical College, Aurangabad, Maharashtra, India
2 Department of Biochemistry, Government Medical College, Aurangabad, Maharashtra, India

Correspondence Address:
Anil Kumar
Department of Medicine, Govt. Medical College, Aurangabad - 431001
India
How to cite this article:
Kumar A, Surwade G A, Khaire U S, Shende R. Blepharochalasis. Indian J Dermatol Venereol Leprol 2001;67:216-217
Copyright: (C)2001 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Two cases of blepharochalasis, underwent cosmetic blepharoplasty, follow-up for 5 years revealed no progression.
Keywords: Blepharochalasis

Introduction

Blepharochalasis is a rare degenerative disease unique to the skin of the lids, clinically characterised by primary bilateral swelling followed by progressive loss of subcutaneous tissue resulting in fine wrinkling and the skin of the upper lid hangs in thin folds.[1] It is also termed ptosis atonica, ptosis adiposa and dermatolysis palpebrum. However the term blepharochalasis (Greek meaning eye lid relaxation) coined by Fuchs in 1896 seems to be most appropriate.[2] The condition starts with recurrent attacks of bilateral lid oedema in the pubertal age, the skin of the upper lid becomes atrophic, discoloured and redundant with tortuous blood vessels. The patient often presents for ptosis due to stretching of the levator palpebrae superioris muscle. Not more than half a dozen cases of blepharochalasis are reported in Indian literature. We report two cases with followup for 5 years.

Case Report

Case 1: An 18-year-old female was referred as a case of recurrent angioedema of upper lids. The patient was alright upto the age of 13 years when she developed bilateral lid oedema which subsided without any treatment. Upto the age of sixteen years she had several attacks of lid oedema at the interval of 5 to 8 months which persisted for two to three days each time. For the last 3 years she had not experienced lid oedema but developed difficulty in opening the eyes completely. Her systemic examination was normal. There was nontoxic puberty goitre but there was no lip oedema. Local examination revealed lax and wrinkled skin of both the upper lids. The redundant skin folds extended over the margins of the lids, tortuous blood vessels were seen in the atrophic skin. Skin on the body was normal. The family history was noncontributory to her illness. Her haematological profile, urinalysis, kidney function, liver function and thyroid function tests were within normal limits. [Figure - 1] The patient was subjected to cosmetic blepharoplasty. The skin tissue obtained during surgical procedure was subjected to histopathological examination. Histopathologically there were scattered and fragmented elastic fibers and also proliferation of capillary endothelium with mild lymphocytic infiltration in dermis and subcutaneous tissue. After discharge the patient was followed-up for five years which revealed no progression in the laxity of the skin.

Case 2: A 25-year-old female presented with progressive laxity and wrinkling of the upper eye lids of 5 years duration. The patient attained menarche at the age of 13 years and since then during her premenstrual phase she noticed intermittent lid oedema which continued till the age of 20 years. On several occasions she underwent haematological investigations, urinalysis and kidney function tests and endocrinal assay, the results of which revealed no abnormality. For last five years, she had no lid oedema but the eye lid skin became lax and wrinkled resulting in difficulty in opening the eyes completely. Her systemic examination was normal. The body skin revealed no abnormality. Routine haematological investigations, urinalysis, kidney function and liver function tests were within the normal limits. With the clinical diagnosis of blepharochalasis, the patient was referred for cosmetic surgery. Histopathology of skin tissue obtained revealed diminished depth of rete pegs and loss of elastic fibres at most of the places. There was proliferation of capillary endothelium, which substantiated the diagnosis of blepharochalasis. The patient was seen after 2 and 5 years of initial presentation which revealed no progression in the laxity of lids.

Discussion

The exact etiology of blepharochalasis is not known. However, the condition being commonly reported during puberty, the role of endocrines is difficult to rule out.[3] In one third of the cases in which the disease starts before the age of 10 years the autosomal dominant heredity probably plays an important role.[1] It however, remains unexplained why the skin of the upper lid is selectively involved. Three stages of blepharochalasis are described.[1] One the intermittent oedematous swelling of upper lids which is usually misinterp, eted until the permanent changes occur. The lid swelling is painless and transient which lasts for a day or two with mild redness of skin resembling angioedema. This state is called the oedema stage. In the second stage the skin becomes discoloured, reddish brown, heavily venuled and flabby and hangs over the lashes and the power to lift the eye lid is decreased. This is the stage of atonicptosis. In the third stage with further progression there is relaxation of the tissues of orbital septum and when the orbital fat drops into the relaxed lid weighing down the skin in full heavy transverse folds, narrowing of palpebral tissue occurs which results in interference with vision. The lacrimal gland may be pulled below the orbital margin giving the face tired debauchery. This is the advanced stage termed as ptosis adiposa. Most of the reported cases presented in the second stage. Though the upper lids are commonly involved, lower lid[4] and unilateral involvement[2] may be seen.

The disorder can be diagnosed with the characteristic history and typical skin lesions.[3],[4],[5]

The redundant eye lids narrow the palpebral fissure interfering with vision, in some patients corneal ulceration may result due to inturning of eye lashes.[6] The only effective treatment is correction of the deformities by plastic surgery, however, subsequent attacks of lid oedema may interfere with surgical repair.[7]

In both the cases presented, the diagnosis of blepharochalasis was made clinically and was substantiated by histopathological examination. Nontoxic thyroid goitre in the absence of lip edema could not be typed as (Leffer) Asher syndrome in one of our cases. Since there was no recurrence of lid oedema the surgery was fruitful in restoring and maintaining the young look in our patients.

References
1.
Duke-Elder S, Mac Faul PA. The ocular adnexa. In: Duke Elder S (Ed), System of ophthalmology. The CV Mosby Company, London, 1974;13(1):350-355.
[Google Scholar]
2.
Collin JRO, Bear C, Stern WH, et al. Blepharochalasis. Br J Ophthalmol 1979;63:542-546.
[Google Scholar]
3.
Gharpuray MB, Patki AH. Blepharochalasis. Indian J Dermatol Venereol Leprol 1989; 55 : 260-261.
[Google Scholar]
4.
Krishna K. Blepharochalasis. Indian J Dermatol Venereol Leprol 1995;61:123-124.
[Google Scholar]
5.
Kar HK, Gautam RK, Jain RK, et al. Blepharochalasis. Indian J Dermatol Venereol Leprol 1994;60:353-354.
[Google Scholar]
6.
Sorsby A. Other tissues lids in: Ophthalmic Genetics, 2nd Ed. Butterworth, London 1970:184-189.
[Google Scholar]
7.
Nicholas TLSurgery of the eye lids and lacrimal drainage apparatusBlepharochalasis. In: Rice TA, Michels RG, Stark WJ (Eds). Operative Surgery, 4th ed. Butterworth, London, 1998;4:42-45.
[Google Scholar]

Fulltext Views
1,549

PDF downloads
583
Show Sections