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The
phenomenon of the drooping skin on the
eyelids can be attributed to two
different main causes:
Dermatochalasis
Dermatochalasis
represents the classical diagnosis for
drooping eyelids, which is caused on one
hand by a natural aging-determined
thinning and attenuation of the
epidermal tissue and a reduction of the
natural skin elasticity [due to the loss
of Elastin], on the other hand due to
the continuing natural facial mimic
motion and particularly high extent of
movement of the tissue in the area of
the upper lids [continuous opening and
closing of the eyes]. Last but not least
the gravity contributes to the sagging
of the concerned skin area.
Dermatochalasis is therefore most often
seen by the patient at the age over 45-50
years. In rare cases dermatochalasis may
cause more serious effects of
pathological and functional nature as:
Conjunctival Hyperemia [red eye
conditions]
Chemosis [conjunctival edema]
Restriction of the upper visual field
Entropion [inward rolling of the lower
eyelid]
Ectropion [open distance between eyeball
and lower eyelid]
Blepharitis [inflammation of the eyelid
edge]
Trichiasis [cornea irritation by
misdirected lashes]
Dermatitis [Eczema]
Health disturbances like the Ehlers
Danlos syndrome, tendency to excessive wrinkle
formation [Cutis laxa], thyroid eye
disease, kidney complaints or amyloidosis
may accelerate the development of
dermatochalasis. Patients with
chronic blepharitis, trichiasis or
chronically dry eyes should undergo an
examination to accordingly be treated
before any correction operation.
If examination reveals any other
indications of underlying systemic
disorders as to the kidneys or
thyroides, then these may be eliminated
after diagnostic confirmation by an
appropriate treatment. In the ideal case
this will be done before a planned
blepharoplasty operation.
In the normal case however,
dermatochalasis represents a common
physiologic ageing condition, which
concerns to varying degrees nearly all
patients over the age of 50 years, and
generally it results in a purely
cosmetic problem. The patient usually complains
an older look or tired appearance
because of the relaxed eyelids or the
so-called puffy bags (which are
sometimes also caused by an accumulation
of orbital fat, called 'steatoblepharon']
in the lower lids.
Drooping eyelids by dermatochalasis are
usually corrected with the operation
of the:
·
Blepharoplasty
[eyelid lift].
In
the case of hernied fat accumulation in
the lower lid, the problematic is
usually corrected with the:
·
Transconjunctival
Blepharoplasty
[eyelid lift].
Blepharochalasis
The Blepharochalasis is an atypical,
pathologic condition. I.e. it arises
more rarely than the
dermatochalasis and appears to be of
inflammatory nature. It may occur also only
on one eye (unilateral) and concerns
usually the upper lids. Blepharochalasis
is most often seen by younger and active
patients at the age around 30 years. The
clinical findings of the
blepharochalasis include the attenuation
(thinning), atrophy and drooping [ptosis]
of the eyelids, caused by frequent
swelling of the eyelids. Repeated
swelling causes a stretching of the
skin, that frequently results in a
permanent skin excess and drooping lids.
In essence, the typical blepharochalasis
patient shows a skin surplus and/or a
skin drooping and reduced adhesion
of the eyelid skin at the underlying
muscle and connective tissue, which may
lead even by younger and active patients
to a significant visual impairment. By
some patients exists a genetic predisposition
toward development of blepharochalasis
in an early age.
Blepharochalasis is most frequently of
idiopatic nature [i.e. the cause remains
unknown], it is however in some rare
cases connected also to a renal disorder
(kidney agenesis) or vertebral disturbances
[spinal abnormalities] or congenital
heart disturbances, which have to be
accordingly treated.
Similarly to the dermatochalasis, also
by the blepharochalasis-patient the
problematic of the drooping eyelids may
be corrected with:
·
Blepharoplasty
[eyelid
lift] operation.
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