Dermatochalasis

Causes Droopy Eyelids

Dermatochalasis is a disorder of the eyelids characterized by redundant, thin and flaccid eyelid skin and muscle.  Dermatochalasis and the resultant droopy eyelid is a result of the aging process and is much more common in elderly people although dermatochalasis does appear in younger people as well.  It is usually first noticed in the 40’s and then continues to worsen.  Dermatochalasis occurs with equal frequency in males and females and in all races.

Causes of Dermatochalasis

Dermatochalasis usually affects the upper eyelid but the lower lid may be affected also.  Dermatochalasis is caused by gravity over time, loss of elasticity within the skin, thinning of the epidermis (skin) and weakening of connective tissue in the eyelid.  The orbital septum is inside the eyelid and keeps tissue surrounding the orbit outside of the eyelid. 

Some people are genetically predisposed to dermatochalasis. Several systemic diseases that predispose a person to dermatochalasis are thyroid eye disease, renal failure, trauma, Ehlers-Danlos syndrome, amyloidosis and xanthelasma. 

Complications from Dermatochalasis

In addition to the appearance of droopy eyelids, the primary consequence of dermatochalasis is loss of the superior field of vision.  Other complications include dermatitis (inflammation of the skin), blepharitis (inflammation of the eyelids), ectropion (turning out of the eyelid) and entropion (turning in of the eyelid).   Most of these conditions can cause eye irritation, redness, watering, keratitis and intermittent blurred vision. 

Dermatochalasis is primarily a cosmetic  problem. However, Dermatochalasis can also obstruct the superior visual field when the eyelid sags low enough to block a large portion of the eye and subsequently blocks the superior visual field  causing difficulty with general visual tasks and reading and driving. In advanced cases of dermatochalasis up to 50% of the visual field can be obstructed causing significant vision problems.  Dermatochalasis can also cause frontal headaches from constantly lifting the eyebrows to see.   

Treatment for Dermatochalasis

The most common treatment for dermatochalasis is a surgical procedure known as a blepharoplasty (eye lift).  In this procedure redundant skin, muscle and tissue is removed and the remaining eyelid skin is attached to healthy tendon and connective tissue of the face.  The recovery time is about two weeks to a month and it is possible for the condition to recur over time requiring further surgery. 

If there is a loss of some of the superior visual field proven by a computerized visual field test, most health insurance companies will then pay for a blepharoplasty as being medically necessary.  Without a loss of visual field the procedure is usually ruled cosmetic only and not covered by health insurance.