The exact pathogenesis of blepharochalasis is unknown, but there have been hereditary and immunologic links. Hormonal changes occurring during puberty may be a factor in the development of blepharochalasis. Motegi et al reported histological examination revealing perivascular and interstitial infiltration of lymphocytes in the dermis with a marked decrease of elastic fibers. Immunofluorescence analyses suggested that MMP-3 and MMP-9 might play a role in the development of blepharochalasis as well. Others have shown increased immunoglobulin A (IgA) activity.
While blepharochalasis is usually idiopathic and sporadic, a link has been suggested to the rare Ascher syndrome (swollen upper eyelids and lips, occasionally in conjunction with a euthyroid goiter).
No specific causative triggers or exposures have been reported, but patients may report preceding allergy symptoms, crying, fevers, bee stings, stress, or physical activity.
H02.30 – Blepharochalasis unspecified eye, unspecified eyelid
47704002 – Blepharochalasis
- Dermatochalasis – While this disease entity sounds like blepharochalasis, it is quite different and refers to age-related laxity and redundant upper eyelid skin. This is also much more common in older individuals.
- Preseptal / orbital cellulitis – This would be associated with fevers, skin warmth, and possible globe involvement (ocular motility restriction, relative afferent pupillary defect, etc). Blepharochalasis does not affect the globe.
- Floppy eyelid syndrome – This typically occurs in overweight individuals with obstructive sleep apnea. Further, floppy eyelid syndrome is constant and does not "come and go" like blepharochalasis.
- Thyroid eye disease – This is associated with proptosis, scleral show, globe involvement, and enlargement of extra-ocular muscles on imaging.
- Idiopathic orbital inflammation (IOI) – While this can have a relapsing and remitting course, usually other parts of the orbit are affected. IOI responds to steroids while blepharochalasis has not been reported to.
- Hereditary angioedema – Typically affects other parts of the body.
- Contact dermatitis
- Lacrimal gland inflammation (dacryoadenitis) – Signs are more focal to the lacrimal gland area, while blepharochalasis typically involves the entire eyelid.
- Lacrimal gland tumor