History
Patients report repeated episodes of painless swelling of one or both eyelids with subsequent thinning of eyelid skin, typically starting at approximately age 10–20 years. [7] Edema is almost always observed initially in the upper eyelids. Most cases occur bilaterally, but unilateral instances have been reported. The frequency of attacks is widely variable with symptoms lasting anywhere from hours to days, averaging 2 days. [2] A preceding period of physical or emotional stress may be reported. A history of allergy is occasionally elicited. [6]
Physical Examination
In the early active phase, patients present with nonerythematous edema of one or both upper eyelids. Patients rarely (and only in severe cases) present with nonerythematous edema of the lower eyelids. Thinning of the eyelid skin may be present in the active stage of the disease. Other physical findings include proptosis, blepharoptosis, blepharophimosis, conjunctival injection, and eyelid malposition.
Sequelae of the active phase of the disease characterize the atrophic phase of blepharochalasis. These sequelae include the following:
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Severe thinning of eyelid skin (iris may be visible through the eyelid skin)
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Fine wrinkling of the eyelid skin (cigarette-paper skin)
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Stretched, redundant eyelid skin, occasionally causing visual obstruction
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Subcutaneous telangiectasia
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Pigmentary skin changes (bronze deposits)
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Upper blepharoptosis with levator aponeurosis dehiscence
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Acquired blepharophimosis due to canthal tendon dehiscence
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Medial fat pad atrophy with pseudoepicanthal folds
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Orbital fat prolapse
Complications
Complications associated with blepharochalasis include but are not limited to: [6]
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Blepharoptosis
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Prominent eyelid vacularity
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Orbital fullness
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Orbital fat pad atrophy
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Bilateral lacrimal gland prolapse in the quiescent stage of blepharochalasis syndrome. Courtesy of Kathleen Duerksen, MD.
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Upper and lower eyelid edema in blepharochalasis syndrome. Notice the left pseudoepicanthal fold. Courtesy of Kathleen Duerksen, MD.
