eMedicine Specialties > Ophthalmology > Lid

Dermatochalasis: Differential Diagnoses & Workup

Author: Grant D Gilliland, MD, Private Practice, Texas Ophthalmic Plastic, Reconstructive and Orbital Surgery Associates
Contributor Information and Disclosures

Updated: Nov 2, 2007

Differential Diagnoses

Entropion
Floppy Eyelid Syndrome

Other Problems to Be Considered

Blepharochalasis
Steatoblepharon

Workup

Laboratory Studies

  • In most cases, no laboratory work is necessary.
  • In rare cases where hereditary angioedema is suspected, a C1-esterase inhibitor level should be performed.
  • Similarly, if amyloidosis is suspected, then a protein electrophoresis is appropriate.
  • If thyroid disease is suspected, thyroid-stimulating hormone serum (TSH) should be estimated.

Imaging Studies

  • In most cases, no imaging studies are necessary.
  • If a patient is noted to have proptosis or enophthalmos, CT scan of the orbit is indicated.

Other Tests

  • Basic secretor tear function testing should be performed in most patients who desire blepharoplasty.
  • Other tear function testing, including Schirmer test I and Schirmer test II, may be indicated.

Procedures

  • Blepharoplasty is the procedure of choice for upper and/or lower eyelid dermatochalasis. This can be combined with fat removal in patients with steatoblepharon.
  • In patients noted to have ptosis of the upper eyelid, a concurrent ptosis surgery may be indicated. Similarly, patients with lower eyelid laxity or malposition may require corrective surgery.
  • Periocular fillers may be considered in patients with minor hollowing, steatoblepharon, or lid abnormalities. Several authors have also proposed the injection of periocular fillers in place of blepharoplasty for periorbital rejuvenation.1

Histologic Findings

In most cases, normal skin and muscle are identified. With dermatitis, a chronic nonspecific inflammatory infiltrate may be seen.

More on Dermatochalasis

Overview: Dermatochalasis
Differential Diagnoses & Workup: Dermatochalasis
Treatment & Medication: Dermatochalasis
Follow-up: Dermatochalasis
Multimedia: Dermatochalasis
References
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References

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  2. Prado A, Andrades P, Danilla S, Castillo P, Benitez S. Nonresective shrinkage of the septum and fat compartments of the upper and lower eyelids: a comparative study with carbon dioxide laser and Colorado needle. Plast Reconstr Surg. May 2006;117(6):1725-35; discussion 1736-7. [Medline].

  3. Korn BS, Kikkawa DO, Schanzlin DJ. Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome. Plast Reconstr Surg. Jun 2007;119(7):2232-9. [Medline].

  4. Abell KM, Cowen DE, Baker RS, Porter JD. Eyelid kinematics following blepharoplasty. Ophthal Plast Reconstr Surg. Jul 1999;15(4):236-42. [Medline].

  5. Alfonso E, Levada AJ, Flynn JT. Inferior rectus paresis after secondary blepharoplasty. Br J Ophthalmol. Aug 1984;68(8):535-7. [Medline].

  6. American Academy of Ophthalmology. Functional indications for upper and lower eyelid blepharoplasty. Ophthalmology. Apr 1995;102(4):693-5. [Medline].

  7. Bernardino CR. Re: improvement of dermatochalasis and periorbital rhytids with a high-energy pulsed CO laser: a retrospective study. Dermatol Surg. Dec 2004;30(12 Pt 1):1500; author reply 1500. [Medline].

  8. Brown MS, Siegel IM, Lisman RD. Prospective analysis of changes in corneal topography after upper eyelid surgery. Ophthal Plast Reconstr Surg. Nov 1999;15(6):378-83. [Medline].

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  10. Cheng JH, Lu DW. Perilimbal needle manipulation of conjunctival chemosis after cosmetic lower eyelid blepharoplasty. Ophthal Plast Reconstr Surg. Mar-Apr 2007;23(2):167-9. [Medline].

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  13. Frankel AS, Kamer FM. The effect of blepharoplasty on eyebrow position. Arch Otolaryngol Head Neck Surg. Apr 1997;123(4):393-6. [Medline].

  14. Ghabrial R, Lisman RD, Kane MA, Milite J, Richards R. Diplopia following transconjunctival blepharoplasty. Plast Reconstr Surg. Sep 1998;102(4):1219-25. [Medline].

  15. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. Blindness following blepharoplasty: two case reports, and a discussion of management. Ophthalmic Surg. Feb 1990;21(2):85-9. [Medline].

  16. Gonnering RS, Sonneland PR. Ptosis and dermatochalasis as presenting signs in a case of occult primary systemic amyloidosis (AL). Ophthalmic Surg. Jul 1987;18(7):495-7. [Medline].

  17. Griffin RY, Sarici A, Ayyildizbayraktar A, Ozkan S. Upper lid blepharoplasty in patients with LASIK. Orbit. Jun 2006;25(2):103-6. [Medline].

  18. Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg. Jun 2004;113(7):2124-41; discussion 2142-4. [Medline].

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  20. Kosmin AS, Wishart PK, Birch MK. Apparent glaucomatous visual field defects caused by dermatochalasis. Eye. 1997;11 (Pt 5):682-6. [Medline].

  21. McKinney P, Zukowski ML. The value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation. Plast Reconstr Surg. Oct 1989;84(4):572-6; discussion 577. [Medline].

  22. Morax S, Touitou V. Complications of blepharoplasty. Orbit. Dec 2006;25(4):303-18. [Medline].

  23. Nassif PS. Lower blepharoplasty: transconjunctival fat repositioning. Otolaryngol Clin North Am. Apr 2007;40(2):381-90. [Medline].

  24. Putterman AM, Urist MJ. Reconstruction of the upper eyelid crease and fold. Arch Ophthalmol. Nov 1976;94(11):1941-54. [Medline].

  25. Rees TD, LaTrenta GS. The role of the Schirmer's test and orbital morphology in predicting dry-eye syndrome after blepharoplasty. Plast Reconstr Surg. Oct 1988;82(4):619-25. [Medline].

  26. Vold SD, Carroll RP, Nelson JD. Dermatochalasis and dry eye. Am J Ophthalmol. Feb 15 1993;115(2):216-20. [Medline].

  27. Zimbler MS, Prendiville S, Thomas JR. The "pinch and slide" blepharoplasty: safe and predictable aesthetic results. Arch Facial Plast Surg. Sep-Oct 2004;6(5):348-50. [Medline].

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Further Reading

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Keywords

blepharochalasis, steatoblepharon, blepharitis, blepharoplasty, eyelid surgery, eyelid tissue, eyelid skin, redundant skin, lax eyelid skin, eyelid laxity, epidermis thinning, skin redundancy, visual field loss, visual field defect

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Contributor Information and Disclosures

Author

Grant D Gilliland, MD, Private Practice, Texas Ophthalmic Plastic, Reconstructive and Orbital Surgery Associates
Grant D Gilliland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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