dermatochalasis

Dermatochalasis is a condition characterized by lax, redundant skin of the eyelids, most often the upper lid, resulting from aging and loss of skin elasticity. The excess skin forms folds that can hang over the lashes and, when severe, obscure the superior visual field.

Etiology and risk factors: Age-related degeneration of collagen and elastin, thinning of the dermis, and weakening of the orbital septum contribute to skin redundancy. Risk factors include advanced age, obesity, chronic sun exposure, smoking, and a family history.

Clinical features: Patients may seek treatment for cosmetic concerns or functional impairment. Redundant skin can create a hooded appearance and may interfere with blinking. When the skin margin encroaches on the visual axis, it can reduce peripheral vision and contribute to visual field obstruction. Dermatochalasis can coexist with true ptosis.

Diagnosis: Diagnosis is clinical, based on examination of eyelid skin redundancy. Assessment of functional impact may include visual field testing if visual obstruction is suspected. Photographs help document severity.

Treatment: Indications include cosmetic concerns and functional impairment. Upper eyelid blepharoplasty, involving removal of redundant skin (and sometimes fat) with or without repositioning of the brow, is the standard surgical treatment. When true ptosis or levator dysfunction coexists, ptosis repair may be performed in addition to blepharoplasty. Non-surgical management is limited and includes lubricating eye drops for symptoms but does not correct the excess skin.

Prognosis and complications: Outcomes are generally favorable with surgery, with improvement in appearance and, when indicated, in visual fields. Complications can include infection, hematoma, scarring, lid malposition or dry eye.