Drooping eye skin or eyelids filled with fat are not only a visual problem, but can also obstruct vision. We are talking about dermatochalasis, which can occur due to a disease or also due to family history. In almost all cases, the affected person must be treated surgically.
What is dermatochalasis?
Under a dermatochalasis, the medical profession refers to a change in the connective tissue. The change occurs due to age, and familial clusters have sometimes been observed. The term dermatochalasis occurs not only in ophthalmology, but also in the field of dermatology. Characteristic are flaccid, large and inelastic wrinkles, which are nothing else than a “sagging skin“, which can appear on different parts of the body. In particular, patients complain of sagging skin around the eyes, or are often affected by bags under the eyes or even drooping eyelids. Dermatochalasis is – strictly speaking – an age-related malposition of the eyelid.
Causes
Due to the fact that the connective tissue slackens with age, the process occurs that fat is deposited in the tissue layers. As a further consequence, the skin bulges forward and the skin begins to sag. Possible causes are, for example, hereditary diseases of the connective tissue, whereby physicians also speak of a cutis laxa syndrome. But also idiopathic recurrent swelling of the upper eyelids (blepharochalasis) as well as age-related reasons (cutis laxa senilis) can trigger dermatochalasis. Sometimes inflammatory skin diseases (dermatitis) can also promote dermatochalasis. Dermatochalasis may also occur during pregnancy; especially if the pregnant woman is taking penicillamine (cutis laxa acquisita).
Symptoms, complaints, and signs
The slackening of the connective tissue primarily ensures that the skin of the upper eyelid is no longer tight and sometimes the excess skin, which has formed due to fat storage, protrudes over the edge of the eyelid. The affected person not only complains about aesthetic problems, but can sometimes also – when he wants to open the eye – feel a stronger resistance. As a consequence, the patient suffers from headaches; this condition is triggered by the fact that a significantly higher effort is required when the patient wants to open the eye. Occasionally, however, an enormous restriction of the visual field can also develop, if the eyelid becomes “ever larger”. If this occurs, the cosmetic problem becomes a medical problem, and the ophthalmologist is usually responsible for such treatments and diagnoses. At the latest when the restriction of vision is perceived as disturbing, a medical professional should therefore be consulted immediately to look at or treat the dermatochalasis.
Diagnosis
The ophthalmologist can – in the context of an ophthalmologic examination – make the diagnosis of dermatochalasis. However, it is important that a differential diagnosis is made so that the suspicion of dermatochalasis can also be confirmed. It is important that diseases such as Williams-Beuren syndrome, Ehlers-Danlos syndrome, progeria (also known as Hutchinson-Gilford syndrome), Barber-Say syndrome, Costello syndrome, Kabuki syndrome, pseudoxanthoma elasticum or cardio-facio-cutaneous syndrome can be excluded. Therefore, as part of the diagnosis, close attention must be paid to the eyelids, so that the position of the eyelid edge is particularly relevant. If the edge of the eyelid is unchanged or merely covered by the skin, the diagnosis is dermatochalasis and ptosis can be excluded. The physician also performs a measurement of the visual field so that any visual field loss can be assessed. Often, the medical professional can already suspect dermatochalasis based on the visual examination. The course is based on its cause. As a rule, if dermatochalasis causes not only aesthetic but also medical problems, the affected person must be treated surgically over time.
Complications
In most cases, both cosmetic and physical complications occur with dermatochalasis. In addition to reduced aesthetics, the patient’s vision is also prevented due to the enlarged eyelids. This requires the patient to exert increased effort to open the eye.Due to the increased force, headaches often occur as well. These can spread to neighboring regions, so that teeth or ears are also affected by pain, although there is no causative complaint in these regions. Similarly, vision is severely limited, which can lead to considerable restrictions in the daily life of the affected person. Dermatochalasis can be diagnosed and must usually be treated immediately. If the condition is acute and severe, surgical intervention can be performed. This usually proceeds without complications. If there is no need for surgery, the underlying disease can also be treated with physiological methods. Here, too, there are no further complications and the course of the disease is positive. After the operation, small scars often remain on the eye. Life expectancy is not reduced by dermatochalasis.
When should you go to the doctor?
Whether and what the patient himself can do to improve his condition depends on what the dermatochalasis is due to and how pronounced the condition is. In the early stages, the patient can try to combat the disorder with the help of special gymnastic exercises for the face and eye. Connective tissue massages can also have a positive effect. If the drooping eyelids are caused by dermatitis or other inflammatory skin diseases, alternating warm eye showers or cold compresses can help. If the upper eyelids are very swollen, ice cubes wrapped in a paper handkerchief can help. Dabbing with eyebright tea, which has previously been placed in the freezer for some time, is also helpful. The application of ice-cold cucumber slices also often leads to a reduction in swelling. If the disorder is due to an allergy, the allergen must be identified and avoided. In the case of various food intolerances, a general change in diet may be useful. In naturopathy, this is usually recommended as a therapeutic method for chronically swollen eyelids. In severe cases, especially if dermatochalasis is genetic or due to age, only surgery will help. Since the procedure involves only manageable risks, patients who suffer from the disorder physically or mentally should promptly find out about the possibility of surgical treatment.
Treatment and therapy
As part of the treatment, the medical professional must consider the cause. Depending on the cause, there are different therapeutic approaches; on the one hand, there are conservative options that include, for example, gymnastics, connective tissue massages or cold-warm showers, but also surgical treatments. These include blepharoplasty. It is advisable that – if there is an underlying disease that has caused dermatochalasis – mainly only the symptoms or the cause – in the sense of the underlying disease – is treated. If the physician decides on the most common variant – i.e. surgical intervention – he removes the excess skin. The patient is treated with local anesthesia; the correction takes about 45 minutes (for both eyes). In the process, the physician first removes the excess skin and secondarily the excess fatty tissue that has formed. After five to six days, the doctor then removes the sutures. Bruising, which may very well occur, heals after about one to two weeks. The procedure leaves a very fine and gentle scar, which is located directly in the crease of the eyelid and is not visible. Before the procedure, of course, a detailed explanatory discussion must take place, in which the patient not only expresses his wishes, but at the same time the physician also reports on risks and other side effects that are possible in the context of a surgical procedure – at least theoretically.
Outlook and prognosis
In dermatochalasis, there is usually no self-healing and no improvement of symptoms if the disease is not treated. For this reason, sufferers always rely on medical treatment to treat this disease. If dermatochalasis is not treated, those affected will suffer from severe fatty deposits on the eyelids and will continue to have difficulty opening and closing their eyes. These complaints have a negative impact on the patient’s quality of life and can reduce it.Likewise, there are limitations in the field of vision and thus also in everyday life. Often, those affected also suffer from headaches and visual complaints due to dermatochalasis. Dermatochalasis can usually be treated relatively easily. The deposits are removed through a surgical procedure, so that the complaints are completely resolved. There are no particular complications, so that the course of the disease is positive. However, a small scar remains. Surgery is not always necessary, so in some cases dermatochalasis can be treated by massage or cold-warm showers. This can also lead to a positive course of the disease.
Prevention
As a rule, dermatochalasis cannot be prevented. This is because in the predominant case other diseases are responsible for dermatochalasis. Even if dermatochalasis has already occurred in the family, there are no preventive measures.
Follow-up
In the case of dermatochalasis, the affected person usually has very few or even no measures or options for aftercare. Since in many cases the disease can also not be treated completely, the affected person is primarily dependent on the early and rapid detection and subsequent treatment of the disease. Dermatochalasis cannot be cured on its own, so treatment is necessary in any case. The earlier dermatochalasis is detected, the better the further course of the disease usually is. The treatment is usually carried out with the help of surgical interventions. These should be performed as early as possible. After such an operation, the patient should always rest and continue to take care of his body. Bed rest should always be observed. Also from efforts or from stressful activities is to be refrained thereby. The procedure for dermatochalasis is usually performed without complications and leads to almost complete healing of the symptoms. It also does not reduce the life expectancy of the affected person. Since the disease can not infrequently lead to psychological upsets or depression, an accompanying, psychological treatment is recommended.
What you can do yourself
Dermatochalasis does not always need to be treated medically. Depending on the cause, there are various therapies, some of which can be carried out without medical assistance. In mild cases, the skin changes can be treated, for example, by gymnastics or connective tissue massages. Cold-warm showers help especially with swelling of the upper eyelids and skin changes as a result of inflammatory skin diseases such as dermatitis. In general, classic face masks with curd or cucumber are also said to have a preventive effect. Homeopathic remedies such as healing earth or Schüssler salts No. 6 and No. 9 help with dermatochalasis caused by allergies. Dermatochalasis during pregnancy can be treated by changing the medication (usually the drug penicillamine is causative). If the drooping of the eyelids is due to age, dermatochalasis usually needs to be surgically removed. A change of diet or changes in lifestyle (e.g. more sleep or less stimulants) prevent new skin changes. In some cases, however, dermatochalasis is genetically determined, which is why sagging cannot always be prevented. In severe cases, therefore, a [psychologist|psychological counseling]] may also be useful. Affected persons should discuss in detail which measures may be considered with the responsible physician.
