Blepharochalasis

What is Blepharochalasis?

Blepharochalasis, sometimes referred to as blepharochalasis syndrome, occurs when the eyelids suddenly become inflamed and swell. It’s a rare condition that typically affects the upper eyelids, generally on both sides of the face. Some instances of lower eyelid blepharochalasis exist but are extremely rare.¹

WIth blepharochalasis you would typically experience painless eyelid swelling every few months. The swelling lasts about 2-3 days. Such flare-ups peak around adolescence and decrease over time, eventually ending as you reach adulthood.²

Because of the low case reports, doctors know little about the causes of blepharochalasis or how to prevent it. Some researchers believe that hormonal changes, such as puberty, can lead to blepharochalasis because the disease affects adolescents. There are no widely available treatments for blepharochalasis that research has proven effective.²

Key Points

• Blepharochalasis is a painless eye condition that causes sudden swelling of the eyelid tissues. 
• The causes of blepharochalasis are unknown, and there are currently no treatments that have been effective in reducing swelling.
• Complications can occur due to the eyelid skin and tissues stretching, often requiring surgery.

Understanding Blepharochalasis

Blepharochalasis is a rare disorder that begins in childhood and peaks in adolescence. Although the condition itself does not cause pain or vision loss, recurrent attacks can cause eyelid stretching and drooping that can interfere with eyesight.² Some, but not all, patients experience erythema (redness) on and around the eyelid.¹

Some patients experience attacks 3-4 times a year for 7-10 years.³

The underlying cause of blepharochalasis is unknown. Some research points to hormones, crying, bee stings, stress, allergies, and upper respiratory conditions as triggers of blepharochalasis.¹

Diagnosis

Diagnosing blepharochalasis is difficult for eye doctors. For one, there are no lab tests available for doctors to run.¹

Secondly, symptoms can present as other eye conditions such as allergic conjunctivitis (eye allergies), styes, floppy eyelid syndrome, angioedema (abrupt swelling of the eyes and lips), lacrimal gland tumors, thyroid eye disease and chalazion.³

Your eye doctor will perform a comprehensive patient history and examination to rule out the differential diagnosis and determine if blepharochalasis is causing your eyelid to swell.³

Complications

The constant stretching of the affected eyelid skin can lead to complications that may require surgical interventions.²

The orbital fat around the eye can prolapse (protrude outward). Eyelid edema (swelling) and wrinkling due to stretching of the elastic fibers, can make patients with blepharochalasis appear older than they are.² Eye doctors typically look for severely thin skin on and around the eyelid, almost resembling “cigarette paper.”¹

Because the levator aponeurosis (fascial tissue that connects the levator muscle to the connective tissue around the eyelids) stretches during attacks, ptosis can occur. Ptosis is when the eyelids droop over the eye and may interfere with vision.⁴ This stretching can also cause the lacrimal glands (needed for tear production) to prolapse.³ Lacrimal gland prolapse can lead to dry eye symptoms.

Medical Interventions

While there are no reliable treatments for blepharochalasis, some findings suggest using steroids may help reduce symptoms but only in a few cases.³ Oral antihistamines, antibiotics and anti-inflammatory medications do not seem to make a difference in reducing swelling.¹

Surgery may be necessary to repair the damage that occurs because of recurrent attacks.³

An eye doctor should perform surgery only when attacks have been at bay for six months or more to reduce the chance of further inflammation and complications.¹

Depending on the severity of complications, doctors can perform eyelid tightening, fat grafting to repair fat atrophy, blepharoplasty (replacing the eyelid crease) and other reconstructive surgeries to repair damaged tissues and muscles.¹

Unfortunately, surgery may not prevent blepharochalasis from recurring. It can lead to overcorrection in some cases where surgeons pull the eyelid skin too tightly or replace it in an unnatural position, which leads to dry eyes and other complications.¹