Generic selectors
Exact matches only
Search in title
Search in content
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 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
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 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
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
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
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
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
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2009:75:2;197-199
doi: 10.4103/0378-6323.48680
PMID: 19293520

Blepharochalasis

Polavarapu Mercy, Ashok Ghorpade, Manabendra Das, Abdulla Soud, Shruti Agrawal, Ashok Kumar
 Department of Dermatology, Venereology and Leprosy, J.L.N Hospital and Research Centre, Bhilai-490 006, Chhattisgarh, India

Correspondence Address:
Ashok Ghorpade
1B, Street 13, Hospital Sector, Bhilai, Chhattisgarh
India
How to cite this article:
Mercy P, Ghorpade A, Das M, Soud A, Agrawal S, Kumar A. Blepharochalasis. Indian J Dermatol Venereol Leprol 2009;75:197-199
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Blepharochalasis is a rare degenerative disease of the skin of the eyelids, characterized clinically by bilateral or unilateral swelling followed by laxity, atrophy, wrinkling and pigmentary changes, predominantly of the upper eyelids. [1] The skin of the eyelids becomes so lax that it droops as redundant folds over the lid margins. [2] The term blepharochalasis was first coined by Fuchs in 1869, meaning eyelid relaxation in Greek. [3] It is also termed ptosis atonia, ptosis adipose and dermatolysis palpebrum .

A 21-year-old female presented with laxity of the skin of the upper eyelids for the past 4 months. The problem first manifested at the age of 16 years, when she developed mild fever of 2 days duration followed by bilateral periorbital swelling. This was followed by a gradual increase in the laxity of the skin of the upper eyelids. She underwent cosmetic blepharoplasty in the plastic surgery department of our hospital 3 years ago. Initially, the results were good but, after 1 year, the skin again became lax following eyelid swelling. She was not given any medical treatment and was advised repeat blepharoplasty after stabilization of her condition. Her family history was not contributory and her twin sister did not have similar complaints.

Local examination revealed lax wrinkled skin of the upper eyelids with no pigmentary changes [Figure - 1]. The skin at other sites was normal. There was no swelling of the lips or the thyroid region. Her systemic examination was normal. Complete hemogram, liver, renal and thyroid function tests were normal.

The exact etiology of blepharochalasis is not known. Most of the cases are sporadic, but autosomal-dominant inheritance has been noted in a few pedigrees. [1] The condition develops insidiously around puberty, characterized by repeated transient attacks of swelling of the eyelids lasting for a few days, followed by laxity, atrophy, wrinkling and pigmentary changes predominantly involving the upper eyelids, although involvement of the lower eyelids [4] and unilateral involvement has been reported. [3] Systemic conditions associated with blepharochalasis are renal agenesis, vertebral abnormalities and congenital heart disease. [5] The eyelid changes cause a lot of cosmetic disfigurement and the affected person looks prematurely aged. About 10% of the cases may have reduplication of the mucous membranes of the upper eyelid, causing apparent thickening of the lids. [1]

Three stages are described in the evolution of blepharochalasis. [2] The first is the recurrent angioedema, while the second stage, which is characterized by discolored, flabby and lax skin, is called the stage of atonic ptosis. In the third stage, there is further relaxation of the tissues of the orbital septum, with prolapse of the orbital fat leading to interference of vision. This stage is called ptosis adipose. Most of the cases are reported in the second stage, as in our case.

Blepharochalasis can be diagnosed with the help of a proper history and characteristic skin changes of the eyelids. [3] Histopathological examination in the early stages shows mild dermal lymphocytic infiltrate while in the late stages, elastic tissue of the lids is fragmented and decreased. [6] A recent report described immunoglobulin A deposits in the residual elastic fibers, implying the involvement of an autoimmune mechanism. [7]

The only effective treatment is correction by plastic surgery after the disease has run its course, otherwise subsequent attacks of lid edema may interfere with the results. [8] Blepharochalasis may be associated with progressive enlargement of the upper lip due to enlargement of the labial salivary glands as well as thyroid swelling in Asher′s syndrome. [8] Ptosis, a common genetic defect, can be distinguished due to the normal appearance of the skin. Generalized cutis laxa and Ehlers-Danlos syndrome may have a similar appearance, but are easily distinguished due to other clinical features. [1] We are reporting this case because of its rare occurrence and its probable relation to fever.

References
1.
Burrows NP, Lovell CR. Disorders of connective tissue. In: Burns T, Breathnach S, Cox N, Griffiths C, editors, Textbook of Dermatology. 7 th ed. Oxford: Blackwell Scientific Publishing; 2004. p. 46.21-46.71.
[Google Scholar]
2.
Duke-Elder S, Mac Faul PA. The ocular adenexa. In: Duke-Elder S, editor. System of Ophthalmology. vol. 13, London: The CV Mosby; 1974. p. 350-5.
[Google Scholar]
3.
Collin JR, Bear C, Stern WH, Schoengarth D. Blepharochalasis. Br J Opthalmol 1979;63:542-6.
[Google Scholar]
4.
Krishna K. Blepharochalasis. Indian J Dermatol Venereol Leprol 1995:61:123-4.
[Google Scholar]
5.
Ghose S, Kalra BR, Dayal Y. Blepharochalasis with multiple systemic involvement. Br J Opthalmol 1984;68:529-32.
[Google Scholar]
6.
Tapaszto I, Liszkay L, Vass Z. Some data on the pathogenesis of blepharochalasis. Acta Ophthal 1963;41:167-75.
[Google Scholar]
7.
Grasseger A, Ramani N, Fritsch P, Smolle J, Hintner H. Immunoglobulin A (Ig A) deposits in lesional skin of a patient with Blepharochalasis. Br J Dermatol 1996;135:791-5.
[Google Scholar]
8.
Nicholos TL. Surgery of eye lids and lacrimal drainage apparatus. Blepharochalasis In. Rice TA, Michels RG, Stark WJ, editors,. Operative surgery 4th ed. vol.4., London: Butterworth; 1998. p. 42-5.
[Google Scholar]

Fulltext Views
62

PDF downloads
12
Show Sections