BLEPHAROCHALASIS

The term blepharochalasis was coined by Fuchs in1896. blepharochalasis originates from the Greek word blepharon meaning eyelid and chalasis meaning relaxing.

It is a rare disorder that typically affects upper lids. It is characterised by intermittent oedema of the lids, with frequent recurrence. It produces eyelid tissue relaxation and latter atrophy. It may be unilateral in some cases. In addition to recurrent attacks of oedema, it is associated with ‘cigarette-paper’ skin and subcutaneous telangiectasia.

CAUSES:

It may be a form of chronic angioedema with localised vascular dilatation and extravasation of proteinaceous fluid. Orbital fat may have increased vascularity and dilated capillaries. 

PATHOGENESIS

Pathogenesis is uncertain, but this condition may be immunogenic in origin. There is abundance of IgA deposits around elastin fibers. Infrequently there may be familial occurrence (autosomal dominant inheritance).

Sometimes blepharochalasis is associated with systemic illnesses such as

• Amyloidosis.
• Dermatomyositis.
• Leukaemia.
• Laffer-Ascher syndrome showing oedema of lips and thyroid enlargement.
• Melkersson-Rosenthal syndrome (triad of recurrent labial oedema, relapsing facial paralysis and fissured tongue) may present with eyelid oedema of unknown cause.

PATHOLOGY

typically shows loss of elastic fibers, Lymphoedema, vasculitis and epithelial atrophy. Stretching of the aponeurotic fibers of levator palpebrae superioris muscle due to recurrent low grade inflammation produces aponeurotic ptosis (drooping) of the lids.

SYMPTOMS:

• Unilateral or bilateral transient painless swelling of the eyelids.
• Unilateral or bilateral swelling of the conjunctiva.
• Proptosis (bulging of the eyeball).
• Prolapse of lacrimal gland.
• Presence of pads of fat due to atrophy of the orbital septum and skin.
• Deep superior sulcus due to fat atrophy.
• Thin atrophic bronze coloured eyelid skin which resembles parchment (thin, flat and stiff) due to atrophy of fat.
• Blepharoptosis (drooping of eyelid) due to thinning and atrophy of aponeurosis of levator palpebrae superioris muscle.
•  
• Pseudoepicanthal folds.

Eyelid changes are exacerbated by normal process of ageing

DIAGNOSIS 

depends upon history of disease and clinical examination. There are no characteristic laboratory findings.

Patient gives history of repeated episodes of painless swelling of one or both eyelids with subsequent thinning of skin, usually affecting people between the ages of 10-20 years. Oedema is initially seen frequently in upper lids. The frequency of attacks is variable. It may be associated with a preceding period of physical or emotional stress. Occasionally, there may be history of allergy.

COMPLICATIONS

• Entropion.
• Ectropion.
• Steatoblepharon (sagging of eyelid tissues due to proplapse of fat below the eyelid).
• Ptosis.
• Excessively thin skin (cigarette-paper skin).

HOMOEOPATHIC MANAGEMENT:

Kali carb-  Lids stick together in morning. Swelling over upper lid, like little bags. Swelling of glabella between brows.

Sepia- black spots in the field of vision; asthenic inflammations, and in connection with uterine trouble. Aggravation of eye troubles morning and evening. Tarsal tumors. Ptosis, ciliary irritation. Venous congestion of the fundus.

Lyco -Sees only one-half of an object. Ulceration and redness of lids. Eyes half open during sleep.

Puls- Lids inflamed, agglutinated. Styes. Veins of fundus oculi greatly enlarged.

Apis mel- Lids swollen, red, śdematous, everted, inflamed; burn and sting. Conjunctiva bright red, puffy.

Ferrum -Red, inflamed, with burning sensation. Feeling as of sand under lids

 Graphites: Eyelids red and swollen