Dermatochalasis

A 78-year-old woman with normal vision presented for a routine eye examination. She complained that her eyelids felt heavy and drooped excessively; this condition made her sleepy, especially when she tried to read in the evening (A).

Dermatochalasis-a common, usually bilateral condition that typically affects elderly persons-was diagnosed. The characteristic redundant upper eyelid skin is caused by stretched tissue that results from years of blinking and eyelid rubbing; fat that protrudes through a weakened orbital septum also may be a contributing factor.

Pseudoptosis was confirmed-and true ptosis ruled out-by taping the excess eyelid skin up and out of the way so that the normal height of the upper eyelids was demonstrated (B) and the patient's superior and lateral visual fields significantly improved in both eyes.

Dermatochalasis may be a true ptosis or, as in this patient, a pseudoptotic condition. Ptotic dermatochalasis occurs when the drooped eyelid is caused by a mechanical problem.

An upper eyelid blepharoplasty is the treatment of choice for dermatochalasis. After the operation, this patient was able to read in the evenings for longer periods and with greater comfort.

[Editor's note: For discussion of another patient with dermatochalasis and related ophthalmologic disorders, see “What's Your Diagnosis?” in the April 1, 2002, issue of CONSULTANT, page 518.]