Dermatochalasis is a medical condition, defined as an excess of

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

in the upper or lower

eyelid An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eye ...

, also known as "baggy eyes." It may be either an acquired or a congenital condition. It is generally treated with

blepharoplasty Blepharoplasty ( Greek: ''blepharon'', "eyelid" + ''plassein'' "to form") is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With ...

Presentation

Associated conditions

People with dermatochalasis often also have

blepharitis Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign object ...

, a condition caused by the plugging of glands in the eye that produce lubricating fluid ( meibomian glands). Dermatochalasis can be severe enough that it pushes the eyelashes into the eye, causing

entropion Entropion is a medical condition in which the eyelid (usually the lower lid) folds inward. It is very uncomfortable, as the eyelashes continuously rub against the cornea causing irritation. Entropion is usually caused by genetic factors. This is d ...

. Weakness in the

orbital septum In anatomy, the orbital septum (palpebral fascia) is a membranous sheet that acts as the anterior (frontal) boundary of the orbit. It extends from the orbital rims to the eyelids. It forms the fibrous portion of the eyelids. Structure In the u ...

may cause the herniation of the orbital fat pads. This is observed as the presence of bulges (fat pads) in the soft tissue of the baggy eyes. It can also be observed in various hereditary connective tissue disorders, including classical Ehlers-Danlos syndrome and

cutis laxa Cutis laxa or pachydermatocele is a group of rare connective tissue disorders in which the skin becomes inelastic and hangs loosely in folds. Signs and symptoms It is characterised by skin that is loose, hanging, wrinkled, and lacking in elast ...

. Dermatochalasis can be a major contributing factor for headaches due to tonic reflex contraction of muscles in an attempt to compensate, which then causes tension-type headaches.

Pathophysiology

Dermatochalasis is caused by a loss of elasticity in the connective tissue supporting the structure of the front portion of the eyelid. Normally, in Caucasians, the

orbicularis muscle Orbicularis muscle may refer to * Orbicularis oculi muscle, a muscle around the eye * Orbicularis oris muscle, a muscle around the mouth {{Disambiguation ...

and overlying skin form a crease near the tarsal border. In dermatochalasis, the excess tissues hangs down, over the front edge of the

. The excess tissue can sometimes obstruct the visual field, especially the superior visual field. In severe cases, it may obstruct as much as 50 percent of the superior visual field.

Treatment

If dermatochalasis is severe enough to obstruct the peripheral or superior visual fields, then it may be treated with a surgical procedure called

. In blepharoplasty surgery, excess skin, muscle and fat are removed. While the improvement of vision is an indication for blepharoplasty on the superior eyelid, if the visual fields are not obstructed, it may be performed for cosmetic reasons. In general, blepharoplasty of the inferior eyelid is considered cosmetic, as dermatochalasis in the lower eyelid does not interfere with vision.

Epidemiology

Dermatochalasis commonly affects the elderly, although sometimes it is congenitally acquired. The elderly version may begin to develop as early as 40 years of age, and it continues to progress with age. The congenital version may begin around 20 years of age. There is no racial predisposition towards developing dermatochalasis, and men and women are equally affected.

References

External links

{{Medical resources , DiseasesDB = 29439 , ICD10 = {{ICD10, H, 02, 3, h, 00 or {{ICD10, Q, 10, 0, q, 10 , ICD9 = {{ICD9, 374.87 , ICDO = , OMIM = 219200 , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeSH = , GeneReviewsNBK = , GeneReviewsName = , SNOMED CT = 58588007 Disorders of eyelid, lacrimal system and orbit