Successful Medical Treatment of Blepharochalasis: A Case Series

Abstract

Oral Acetazolamide in combination with topical hydrocortisone provides effective relief of the periorbital oedema associated with blepharochalasis. In our short series, the cases were improved either with medical therapy alone or in combination with surgery. Relapses following surgery were diminished as a result of prior medical therapy.

Outcome of Levator Reattachment Surgery for Blepharoptosis in Blepharochalasis

“…Studies have reported that treatment with oral acetazolamide may reduce the frequency of acute attacks. 6,8 It is proposed that oral acetazolamide regulates the size of the fenestrae of certain capillary beds, thus reducing leakage. 6 However, none of our patients were treated with acetazolamide.…”

“…Ideal timing for surgery would be after 6 months to a year of an acute attack. 1,8 Patients with chronic blepharochalasis in our study were therefore posted for blepharoptosis correction at least 6 months following an acute attack. Blepharoptosis with good levator function is an almost consistent finding seen in all patients in the chronic stages.…”

“…Good postoperative out comes in terms of lid height and contour were obtained in our study consistent with the findings of previous studies. 1,8 The advantage of levator reattachment lies in the fact that it is possible to titrate the lid position intraoperatively. In addition, as it is done through an anterior approach, ptosis correction can be combined with an upper lid blepharoplasty.…”

Periorbital edema

“…To understand better the more common Spider bite [20,21,63] Dermatographism [59] Hepatitis B [10] Tumor necrosis factor receptor-associated periodic syndrome [60,64] Chagas disease [18] Cutis laxa [65] Trichinellosis [14] Blepharochalasis [57,66,67] Epstein-Barr virus [8,9,68] Eyelid metastasis [69] Ophthalmofilariasis [15] Rosacea [51,52] Pott's puffy tumor [28] Sickle cell orbital infarction [70] Necrotising fasciitis [23] Langerhans cell histiocytosis [71] Ophthalmomyiasis [16] Tolosa-Hunt syndrome [72,73] Blister beetle dermatitis [22] Dermatomyositis [36,39,40,74] Rocky Mountain spotted fever [13] Juvenile dermatomyositis [37,38,75] Amebiasis [19] Sarcoid [76] Leukemia [77] Indeed, by definition, these cases were reportable.…”

Acute episode of eyelid oedema

“…However, in the active/early stage, blepharochalasis is believed to be unresponsive to steroids and antihistamines 1–3. A case report series suggests that a combination of systemic acetazolamide and topical hydrocortisone relieves symptoms, decreases the incidence of occurrences and shortens episodes 4 5. Surgery is the primary treatment for blepharochalasis, but it is not curative 1 3.…”