Dermatochalasis Workup

  • Author: Grant D Gilliland, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 27, 2012
 

Laboratory Studies

In most cases of dermatochalasis, 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.
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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.

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Other Tests

Schirmer testing with topical anesthetic drops may be considered in patients who have significant dry eye symptoms and who desire blepharoplasty.[2] However, most ophthalmic plastic surgeons do not consider Schirmer tear testing to be the medical standard of care in evaluating blepharoplasty patients.[3]

Other tear function testing, including the Schirmer test I, Schirmer test II and the phenol red thread test may be indicated.

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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.[4]

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Histologic Findings

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

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Proceed to Treatment & Management
 
 
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.

Specialty Editor Board

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 College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

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.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A 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 Honoraria Speaking and teaching

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.

References

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Preoperative image prior to upper blepharoplasty.
Postoperative image after upper blepharoplasty.
Preoperative image of a patient with thyroid eye disease, dermatochalasis, eyelid retraction, and steatoblepharon.
Postoperative image after 4-lid blepharoplasty and canthopexy.
Pinch technique for measuring redundant skin in upper eyelid blepharoplasty.
 
 
 
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