blepharochalasis is a rare degenerative disease unique to the skin of the lids , clinically characterized by primary bilateral swelling followed by progressive loss of subcutaneous tissue resulting in fine wrinkling and the skin of the upper lid hangs in thin folds .
a 24-year - old female presented with history of interference of vision due to laxity of upper eyelids since 6 years .
she had several attacks of lid oedema at the interval of 4 - 6 months which persisted for one day each time since the age of 14 years .
for the past 4 years she did not experience lid oedema but developed laxity of skin of upper eyelids .
the redundant skin folds extended over the margins of the eyelids . a 23-year - old female presented with right upper eyelid lax skin since the age of 12 years .
there was history of on and off edema of right eyelid for one and a half year before the onset of lax skin .
a 23-year - old male presented with lax and wrinkled skin of lower eyelid since 4 years .
patient gives history of painless swelling of both eyelids associated with erythema on and off since 13 years .
the episodes used to occur daily and used to subside within 2 hours . for the past one year
patient was a known diabetic ( type 1 diabetes mellitus ) since 10 years and on treatment .
all haematological investigations were within normal limits except for case 3 who was a case of type 1 dm .
for first two patients upper eyelid blepharoplasty was done and case 3 underwent lower eyelid blepharoplasty .
preoperative markings were made with the patient sitting upright in neutral gaze with the brow properly positioned .
the upper eyelid was injected with 2% lignocaine with 1:1,00,000 epinephrine and with the help of a no 15 bard parker blade incision was made along the skin markings .
the lower limit of excision was made along the eyelid crease , and the lateral extent of the marking was limited by an imaginary line joining the lateral end of the brow to the lateral canthus .
the extent of excision was made upto 10 mm from the inferior border of the browand medial and central fat was excised along with skin and closed with 7 - 0 absorbable suture [ figure 1 ] . before and after photographs of upper eyelid blepharoplasty transcutaneous lower eyelid blepharoplasty was done by giving an elliptical incision 8 mm below the eyelid margin , excess fat and skin was excised and closed by 7 - 0 absorbable suture [ figures 24 ] .
markings in lower eyelid ( 2 mm below eyelid margin ) showing excised excess skin and fat with closure of the wound with 7 - 0 suture before and after photograph of lower eyelid transcutaneous blepharoplasty
a 24-year - old female presented with history of interference of vision due to laxity of upper eyelids since 6 years .
she had several attacks of lid oedema at the interval of 4 - 6 months which persisted for one day each time since the age of 14 years .
for the past 4 years she did not experience lid oedema but developed laxity of skin of upper eyelids .
a 23-year - old female presented with right upper eyelid lax skin since the age of 12 years .
there was history of on and off edema of right eyelid for one and a half year before the onset of lax skin .
a 23-year - old male presented with lax and wrinkled skin of lower eyelid since 4 years .
patient gives history of painless swelling of both eyelids associated with erythema on and off since 13 years .
the episodes used to occur daily and used to subside within 2 hours . for the past one year
patient was a known diabetic ( type 1 diabetes mellitus ) since 10 years and on treatment .
all haematological investigations were within normal limits except for case 3 who was a case of type 1 dm .
first two patients upper eyelid blepharoplasty was done and case 3 underwent lower eyelid blepharoplasty .
preoperative markings were made with the patient sitting upright in neutral gaze with the brow properly positioned .
the upper eyelid was injected with 2% lignocaine with 1:1,00,000 epinephrine and with the help of a no 15 bard parker blade incision was made along the skin markings .
the lower limit of excision was made along the eyelid crease , and the lateral extent of the marking was limited by an imaginary line joining the lateral end of the brow to the lateral canthus .
the extent of excision was made upto 10 mm from the inferior border of the browand medial and central fat was excised along with skin and closed with 7 - 0 absorbable suture [ figure 1 ] . before and after photographs of upper eyelid blepharoplasty transcutaneous lower eyelid blepharoplasty was done by giving an elliptical incision 8 mm below the eyelid margin , excess fat and skin was excised and closed by 7 - 0 absorbable suture [ figures 24 ] . in all the patients there were cosmetically acceptable results .
markings in lower eyelid ( 2 mm below eyelid margin ) showing excised excess skin and fat with closure of the wound with 7 - 0 suture before and after photograph of lower eyelid transcutaneous blepharoplasty
however , the condition being commonly reported during puberty , the role of endocrines is difficult to rule out . in one third of the cases in which the disease starts before the age of 10 years the autosomal dominant heredity probably plays an important role .
three stages of blepharochalasis are described.[13 ] first stage is the intermittent painless and transient oedematous swelling of upper lids . in the second stage ( atonic ptosis )
the skin becomes discoloured , heavily venuled and flabby and hangs over the lashes and the power to lift the eye lid is decreased . in the third stage
there is relaxation of the tissues of orbital septum and narrowing of palpebral tissue occurrence which results in interference with vision .
the lacrimal gland may be pulled below the orbital margin giving the face tired debauchery .
this is the advanced stage termed as ptosis adiposa.[13 ] though the upper lids are commonly involved , lower lid and unilateral involvement may be seen .
the only effective treatment is correction by plastic surgery after the disease has run its course ; otherwise subsequent attacks of lid edema may interfere with the results .
preoperative patient evaluation for blepharoplasty should document medical and ophthalmologic history . a simple upper or lower eyelid blepharoplasty where only skin or fat is excised can be performed under local anesthesia . for upper eyelid blepharoplasty , preoperative markings should be made with the patient sitting upright in neutral gaze with the brow properly positioned .
the eyelid crease is situated above the ciliary margin approximately 8 to 9 mm in women and 7 to 8 mm in men
. the lower limit of excision should be along the eyelid crease , and the lateral extent of the marking should be limited by an imaginary line joining the lateral end of the brow to the lateral canthus . a minimum of 20 mm of vertical lid height should be preserved for normal eye closure . the location of fat should be determined and marked preoperatively .
skin incision can be made either with a no 15 bard parker blade or the empire tip of radiofrequency monopolar cautery .
the skin incision can be closed using running or interrupted sutures with various absorbable or permanent material .
we report 3 cases of blepharochalasis , of which 2 cases involved upper eyelid ( 1 case was unilateral ) and 1 case involving bilateral lower eyelids .
 blepharochalasis is a rare degenerative disease of skin of lids . 
 we report 3 cases of blepharochalasis , out of which two involved upper eyelids and one involved lower eyelids . 
 all the three cases were treated with transcutaneous blepharoplasty with acceptable cosmetic results . 
INTRODUCTION
CASE REPORTS
Case 1
Case 2
Case 3
Treatment
DISCUSSION
CONCLUSION