INTRODUCTION Blepharochalasis is a rare disorder that usually affects the upper eyelids of young individuals less than 20 years old. The etiology is unknown. IgA deposits have been found within the periorbital tissues suggesting an underlying immune mechanism. Elastin mRNA expression is not decreased in affected eyelids compared to normal control fibroblasts suggesting that environmental or other matrix components of elastin are involved in the loss of elastin fibers. A few cases show an autosomal dominant pattern of inheritance. Blepharochalasis can be associated with other skin disorders such as dermatomyositis.

CLINICAL CHARACTERISTICS Blepharochalasis begins with an early active phase characterized by recurrent episodes of mild, transient, painless eyelid edema. There then follows a later quiescent phase where the eyelid skin becomes redundant and baggy, with atrophic thinning and wrinkling. The upper eyelid skin hangs loosely in folds over the eyelid margin. There may be areas of dehiscence in the orbital septum with fat prolapse into the baggy skin. The levator aponeurosis can be stretched resulting in ptosis, and the lacrimal gland may prolapse into the lateral eyelid. Secondary blepharophimosis, ectropion, and pseudoepicanthal folds may be seen. As the patient ages these changes are exacerbated by normal aging.

TREATMENT Treatment is surgical and may require multiple procedures. Excess eyelid skin is excised as for a standard blepharoplasty and ptosis is corrected with levator aponeurosis advancement. When there is associated fat atrophy, fat grafts may be appropriate. Lacrimal gland prolapse is repaired by refixation to the orbital rim.

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