Dermatochalasis

Edundant and lax eyelid skin and muscle are known as dermatochalasis. Dermatochalasis is a common finding seen in elderly persons and occasionally in young adults. Gravity, loss of elastic tissue in the skin, and weakening of the connective tissues of the eyelid frequently contribute to this lax and redundanteyelid tissue. These findings are more common in the upper eyelids but can be seen in the lower eyelids as well. Genetic factors and family traits may play a role in some patients.

Dermatochalasis can be a functional or cosmetic problem for the patients. When functional, dermatochalasis frequently obstructs the superior visual field. In addition, patients may note ocular irritation, entropion (turned in position) of the upper eyelid, ectropion (turned out position) of the lower eyelid, eyelash infection, and dermatitis. When cosmetic, patients note a fullness or heaviness of the upper eyelids, "bags" in the lower eyelids, and wrinkles in the lower eyelids and the lateral canthus, both of which contribute to an aged appearance.

The most common visual difficulties encountered include loss of the superior visual field, difficulty in reading, and loss of peripheral vision when driving.  In addition, patients with moderate-to-severe dermatochalasis chronically elevate their brows to improve their visual field. This frequently is associated with frontal headaches.  Ocular irritation, dry eyes, and dermatitis also may be the presenting signs of dermatochalasis.

The treatment of dermatochalasis usually involves surgery, either cosmetic or functional (medically necessary).  If the droopy eyelids block more than 20 – 25 of the peripheral vision, insurance may pay for the surgery.Medical therapy may be helpful, and involves eye drops or eye ointment to reduce infection, skin irritation, and dry eye problems that may occurs with droopy eyelids. Surgical care involves an office procedure or outpatient surgery.  The excess skin is measured and removed, with care taken to avoid removing too much skin. Occasionally, removal of excess fatty tissue may be involved, and this helps improve the contour and appearance of the eyelids.