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Blepharochalasis

Swollen eyelids from excess fluid buildup (edema) can occur for several reasons, such as allergies, infections or injuries. They can also be a sign of blepharochalasis, a rare condition diagnosed in fewer than 200,000 people in the U.S. 

Blepharochalasis (pronounced "blef-ah-ro KAL-ah-sis") is an uncommon disorder whereby eyelids experience recurrent attacks of edema. A swelling attack can: 

  • Occur several times a year. The eyelid swelling gets exacerbated and then goes into remission. This worsening-subsiding cycle can happen frequently.

  • Last from a few hours to a few days. 

  • Affect upper and/or lower eyelids and in one (unilateral) or both (bilateral) eyes. 

  • Begin in childhood and can continue into adolescence and adulthood, diminishing in frequency as the years go by.

  • Affect males and females, without preference of one sex over the other.

  • Eventually lead to eyelid laxity, with repeated edema episodes, in which lids become so slack as to obscure fields of vision.

Blepharochalasis can result in functional issues, such as obscuring vision, or cosmetic concerns, like bagginess.

Causes of blepharochalasis 

Blepharochalasis is a rare disorder, and its cause is unknown. Genetics or heredity may be considered risk factors when it comes to blepharochalasis, in that they don’t directly cause the disorder but may increase the chances of developing it.

In light of no specific causes or risk factors, there are some possible triggers — things that may precede an eyelid edema attack — that may shed some light on why blepharochalasis occurs. These triggers include but are not limited to:

  • Hormonal changes during puberty such as menstruation.

  • Eyelid inflammation as a result of environmental factors (wind exposure, bug bites or allergies, etc.) or behavioral factors (crying, fatigue, emotional stress, etc.).

  • Decrease in or loss of elastic fibers in the eyelid tissue.

  • Upper respiratory tract infections.

  • Fever.

  • Eyelid trauma from injury or illness.

  • Immunoglobulin A (IgA) deposits in eyelid skin.

Signs and symptoms of blepharochalasis

An obvious outward sign of blepharochalasis is swelling in which fluids accumulate in and around the eyelid tissues. When poked, the affected skin doesn’t leave an indentation (called non-pitting edema). 

These recurrent attacks of exacerbation followed by remission can take a toll on eyelid skin, leaving its appearance changed. Some signs and symptoms of blepharochalasis include: 

  • Thin and wrinkled skin – The outcome of multiple edema attacks can leave eyelid skin so stretched as to resemble wrinkled parchment paper. 

  • Bagginess – From repeated stretching, eyelid skin gradually loses its shape and effectiveness (atrophy), resulting in redundant skin folds. 

  • Discolored and/or spider veins – Over time as the edema attacks re-occur, eyelid pigmentation can acquire reddish-brown or bronze-colored deposits as well as visible thread-like red lines (telangiectasia).

  • Absence of pain – Unlike swelling associated with inflammation, this type of swelling of the eyelid isn’t painful, even though excess fluid is trapped in the tissues and cannot drain properly.

  • Obscured vision – The swelling can interfere with vision, causing upper eyelids to feel "heavy" and lower eyelids to become abnormally positioned. In addition, the lax skin that occurs after repeated attacks can make upper eyelids so slack that they hang down over the edge of the eye, limiting or obscuring fields of vision.

  • Eye irritations – Over time, the lower eyelids can fold inward (entropion), causing eyelashes to rub against the eyeball, or outward (ectropion), affecting tear drainage.

Swollen eyelids associated with blepharochalasis are often confused with puffy eyelids because they have a similar appearance. However, with blepharochalasis, the swelling is most likely temporary; whereas puffy eyelids may be permanent. The eyelid bagginess or atrophy from blepharochalasis can also be confused with ptosis. However, with ptosis, the eye muscle responsible for opening the upper eyelid is weak or paralyzed, which is what causes the drooping. Ptosis can occur with other conditions, such as blepharochalasis, dermatochalasis or blepharitis.

If you present any of these signs and symptoms, or if they persist, worsen or change, it’s important that you visit your eye doctor.

Blepharochalasis vs. dermatochalasis vs. blepharitis 

Blepharochalasis resembles other eyelid conditions, specifically elements of the laxity with dermatochalasis and of inflammation with blepharitis. It’s important for eye doctors to rule out dermatochalasis and blepharitis in order to correctly diagnose blepharochalasis. 

Here are the characteristics of each: 

Blepharochalasis 

Blepharochalisis refers to episodic attacks of eyelid edema. The eyelid is temporarily swollen by the accumulation of fluids, and after several repeated episodes, it becomes stretched, wrinkly and/or discolored. Other than swelling, blepharochalasis tends to not have other classic characteristics of inflammation such as pain or redness. Treatment involves surgery called blepharoplasty.

Dermatochalasis

Dermatochalsis is a condition that results in excess eyelid skin caused by a decrease in elastin, a protein in connective tissues. Upper and lower eyelids can become permanently saggy, and over time, this redundant skin can be noticeable, especially in older people. If poked or stretched, the affected skin doesn’t snap back easily. Dermatochalasis is treated by blepharoplasty.

Blepharitis 

Blepharitis involves eyelid swelling from clogged oil glands found along the rim of the eyelid near the eyelashes (meibomian glands). A common affliction, it’s due to bacterial infection or allergies. During a bout, the affected eyelid skin is inflamed and may be associated with pain, redness, itchiness, tearing or stinging. Treatment comes in the form of self-care, such as using lubricating eye drops or antibiotic ointment, as recommended by an eye doctor.

Treatment of blepharochalasis

Blepharochalasis can’t be prevented or cured. However, it can be treated by blepharoplasty. As with all eye issues, early diagnosis and treatment are the best courses of action. 

With blepharochalasis, sight itself is not affected; however, as a result of repeated edema episodes, the eyelid may undergo changes that only surgery can correct. 

Surgery for blepharochalasis

Changes in eyelids due to blepharochalasis — obscured vision or eye irritations — may require surgery to correct. If deemed medically necessary for functional reasons, insurance may cover, or partially cover, these procedures.

Surgery can also correct appearance-related issues that may cause premature aging concerns, such as bagginess, discoloration or spider veins. If considered cosmetic or elective, insurance may not cover it.

Blepharoplasty may reduce or eliminate functional or cosmetic issues that occur because of the edema attacks. Typically, surgery for blepharochalasis is scheduled while the eyelid is in the remission stage. 

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