Blepharochalasis Syndrome Treatment & Management

  • Author: Brett S Kotlus, MD, MS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jul 11, 2011
 

Medical Therapy

Thus far, no pharmacologic agents have proven to be beneficial in the treatment of blepharochalasis. The ability of antihistamines, steroids, sympathomimetics, mast-cell stabilizers, and cool compresses to modify the symptoms of acute attacks has not been determined.

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Surgical Therapy

Surgery is performed in patients after at least 6 months of disease inactivity to correct anatomical defects resulting from previous bouts of swelling.

Redundant upper eyelid skin is corrected with the usual blepharoplasty techniques, which may include reforming the eyelid crease with sutures. Excision or sculpting of prolapsed orbital fat may be considered but often in a conservative fashion. A prolapsed lacrimal gland, when present, may also be resuspended.

Upper blepharoptosis is preferably corrected through repair of levator dehiscence or levator advancement. A Fasanella-Servat procedure has been described to repair blepharoptosis associated with this syndrome, but the technique does not precisely address the anatomical defect in question.

Lateral canthoplasty is often effective in repairing blepharophimosis because of attenuation of the lateral canthal support structures. Repair may be accomplished with the attachment of a lateral tarsal tongue to the periosteum on the internal aspect of the lateral orbital rim with nonabsorbable sutures. A periosteal flap or lateral orbital rim drill holes may also be used.

Fat atrophy and a significant superior sulcus defect may be addressed with autologous grafting techniques, including orbital fat repositioning, dermis fat grafting, fat pearl grafts, and aspirated fat transfer. Consider injectable synthetic fillers, such as hyaluronic acid or calcium hydroxylapatite.

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Complications

After correction of the abnormalities present in blepharochalasis, pronounced or prolonged edema may complicate the postsurgical course. The edema may be a manifestation of the underlying disease process responsible for blepharochalasis syndrome. Surgical interventions may be of limited benefit in treating recurrent postsurgical episodes of disease, and this may make postsurgical expectations less predictable.

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Outcome and Prognosis

As individuals age, the frequency of swelling attacks typically subsides. However, unexpected episodes may occur after an extended period of inactivity.

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Future and Controversies

Blepharochalasis may have an orbital component. This has been implied in patients who exhibit proptosis with the disease, and histologic findings in orbital fat biopsies further suggest orbital involvement. Future studies may elucidate this point.

As immunologic and genetic methodologies continue to improve, the etiology of blepharochalasis syndrome will likely be further elucidated. Effective treatments of this potentially disfiguring syndrome will hopefully follow.[8]

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Contributor Information and Disclosures
Author

Brett S Kotlus, MD, MS  Private Practice, Allure Medical Spa; Assistant Clinical Professor, Department of Ophthalmology and Vision Science, University of Arizona Health Sciences Center

Brett S Kotlus, MD, MS is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Phi Beta Kappa

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 Consulting fee Consulting

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.

Acknowledgments

Thanks to Kathleen Duerksen, MD, for contributing the photos.

References

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Bilateral lacrimal gland prolapse in the quiescent stage of blepharochalasis syndrome.
Upper and lower eyelid edema in blepharochalasis syndrome. Notice the left pseudoepicanthal fold.
 
 
 
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