Blepharochalasis
Blepharochalasis is an uncommon condition characterized by recurrent episodes of painless, non-pitting edema of both upper lids which usually resolves spontaneously after a couple of days.
Presentation is typically around puberty, episodes becoming less frequent with time.
Eyelid skin becomes stretched and atrophic, characteristically said to resemble wrinkled cigarette paper; severe cases may produce to stretching of the canthal tendons and levator aponeurosis leading to ptosis, and lachrymal gland prolapse may occur.
A hypertrophic form with orbital fat herniation and anatrophic form with absorption of orbital fat are described
The medical diagnosis includes similarly episodic conditions, particularly drug-induced urticaria and angio edema. Treatment involves blepharoplasty for redundant upper lid skin, and correction of ptosis.
Eyelid imbrication syndrome
Eyelid imbrication syndrome is an uncommon and regularly unrecognized disorder during which the upper lid overlaps the lower on closure in order that the lower lashes irritate the superior marginal tarsal conjunctiva.
It may be unilateral or bilateral and therefore the major symptom isocular irritation. It are often acquired, commonly related to floppy eyelid syndrome, or – very rarely – congenital; occasionally it's going to follow lower lid tarsal strip surgery.
Associated signs include superior tarsal papillary conjunctivitis and rose Bengal staining of the superior marginal conjunctiva. Definitive treatment consists of upper lid pentagon resection and/or lateral canthal tightening
Upper lid retraction
Upper lid retraction is suspected when the upper lid margin is either level with or above the superior limbus.
Where there's no loss or tightness of the upper eyelid skin, retraction is corrected by surgical release of the eyelid retractors, usually via a trans conjunctival posterior approach.
Mild retraction could also be treated with Müller muscle recession.
Moderate to severe retraction may require levator aponeurosis recession.
Lower lid retraction
Inferior scleral show could also be physiological in patients with large eyes or shallow orbits, but is usually involutional or secondary to a number of the conditions.
It may follow lower lid blepharoplasty, when aggressive upward massage of the lid for two or 3 months could also be curative for minor degrees.
In other cases, atarsal strip operation may raise the lid slightly, but when moderate elevation is required inferior retractor recession with a posterior lamellar spacer is probably going to be necessary; more aggressive procedures are described for severe cases.