Blepharochalasis:Clinical and Epidemiological Characteristics, Surgical Strategy and Prognosis-- A Retrospective Cohort Study with 93 Cases

Background: Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data is unavailable. This study aimed o report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow up, the prognosis of different clinical deformities was also investigated. Methods: This is a retrospective cohort study, included consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were scheduled according to the various manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded. Results: A total of 93 patients, with a mean follow-up of 5.29±2.07 (range: 3-10) years before surgery, and 2(range:1-4) years follow-up after surgery were included. Of all those 93 patients, 72.04% were females (67, P =0.02 ). The mean age of onset of blepharochalasis symptoms was 10.09±3.32 (range: 5-16) years, mostly (83.87%) consisted with the onset of the puberty. With the average of 5 times per year, the mean duration of each acute attack was 28.12±1.01 (rang: 2-192)hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4-10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity(29.04%), lower eyelid retraction(17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. Conclusions: Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.