Blepharochalasis: clinical and epidemiological characteristics, surgical strategy and prognosis-- a retrospective cohort study with 93 cases

Abstract

Background Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data are unavailable. This study aimed to report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow-up. The prognosis of different clinical deformities was also investigated. Methods This was a retrospective cohort study, including consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were performed according to manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded. Results A total of 93 patients, with a mean age of 30.77 ± 14.04 (range: 9.00–70.00) years were included. Of all those 93 patients, 72.04% were females (67, P = 0.02). The mean follow-up was 5.29 ± 2.07 (range: 3–10) years before surgery, and 2.07 (range:1.54–4.22)years follow-up after surgery. The mean age of onset of blepharochalasis symptoms was 10.09 ± 3.32 (range: 5–16) years, and 83.87% patients got symptoms in puberty. With an average of 5 times per year, the mean duration of each acute attack was 28.12 ± 1.01 (rang: 2–192) hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4–10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity (29.04%), lower eyelid retraction (17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. Conclusions Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, which might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.

Evaluation and Management of Blepharoptosis

“…The patient's ocular history may also reveal the cause of ptosis. Certain eyelid disorders such as allergic conjunctivitis or blepharochalasis (not dermatochalasis) can cause chronic swelling and itching/lid rubbing leading to levator aponeurosis dehiscence (22). Previous ocular or eyelid surgery/treatment (especially if a lid speculum is used) such as anti-VEGF injections can also lead to tearing or stretching of the aponeurosis (23,24).…”

“…Certain eyelid disorders such as allergic conjunctivitis or blepharochalasis (not dermatochalasis) can cause chronic swelling and itching/lid rubbing leading to levator aponeurosis dehiscence. 22 Previous ocular or eyelid surgery/treatment (especially if a lid speculum is used) such as anti-vascular endothelial growth factor injections can also lead to tearing or stretching of the aponeurosis. 23 24 Chronic use of gas permeable contact lenses can lead to aponeurotic dehiscence 25 and recent periocular botulinum toxin injections for cosmetic or medical reasons (blepharospasm or hemifacial spasm) should be noted.…”

“…Calipers (►Fig. 22) are used to mark the amount of tissue to be resected. If 10mm is to be resected, 5mm is measured and marked on the conjunctiva, with calipers, from the upper edge of the superior tarsal plate.…”

Correction of Lacrimal Gland Ptosis in Blepharoplasty: A Systematic Review

“…9 This pathology is more frequent in women. 12 The prevalence of lacrimal gland ptosis in the general population is around 10% to 15% in Caucasian patients, 11,13 reaching up to 60% in the elderly population. 14 It can be assessed in a complementary manner by eversion of the upper eyelid while the patient looks down, resulting in the finding of a pink lobulated mass deep to the palpebral conjunctiva of the upper fornix, which is called "supine test."…”

“…17 The correction of lacrimal gland ptosis has already been described by several authors in the literature. 3,9,[12][13][14][18][19][20][21][22][23][24][25][26][27] However, most of these series found are small and there is no literature review that compiles and synthesizes their results and possible complications.…”