Dermatochalasis is an eye condition involving excess skin on the upper or lower eyelids, often called “baggy eyelids.” The skin, having lost its elasticity, can hang or droop, creating a hooded appearance. The condition results from the weakening of connective tissues that provide structure to the eyelids.
Symptoms and Causes of Dermatochalasis
Individuals may experience a sensation of heaviness in their eyelids or find that the excess skin obstructs their upper field of vision. This can lead to difficulty with activities like reading. In some cases, the skin can fold over and cause irritation or even skin breakdown in the outer corners of the eye.
The primary cause is an age-related loss of elasticity in the eyelid skin. As supportive connective tissues weaken and fibers like collagen and elastin break down, the skin loses firmness and sags. While aging is the main driver, certain factors can accelerate this process. Genetics play a role, making some individuals more predisposed to the condition. Other contributors include chronic sun exposure, smoking, and a high body mass index.
Differentiating Dermatochalasis from Ptosis
Dermatochalasis is characterized by redundant skin that hangs over the edge of the eyelid. The underlying muscle that opens the eye and the position of the eyelid margin itself are in their normal locations.
In contrast, ptosis, or blepharoptosis, involves the drooping of the upper eyelid margin itself. This is not an issue of excess skin, but a problem with the levator muscle that lifts the eyelid. This muscle may be weakened or damaged, causing the entire eyelid to sit lower than normal, potentially covering the pupil. To visualize the difference, think of dermatochalasis as excess fabric hanging over a curtain rod, while ptosis is like the entire curtain rod sagging downward.
Evaluation and Surgical Treatment
An evaluation for dermatochalasis involves a physical examination by a specialist. To determine if the condition is functionally significant, a visual field test may be performed. This test measures a person’s peripheral vision and can document whether the drooping skin is physically blocking sight. Documenting a functional impairment is often necessary for insurance coverage of the treatment.
The standard treatment for dermatochalasis is a surgical procedure known as blepharoplasty. Performed under local anesthetic, this surgery involves the removal of excess skin, and sometimes small amounts of muscle and fat, from the upper or lower eyelids. The surgeon makes incisions that are carefully hidden within the natural folds and creases of the eyelid. This technique allows for the restoration of an unobstructed field of vision and a less tired appearance, with scars that are typically not visible once healed.