Blefarokhalazis – the ophthalmologic disease which is characterized by an atrophy of skin of upper eyelids with formation of excess folds over palpebralny edge. Main clinical manifestations: a "meshkopodobny" overhang of upper eyelids, deterioration in sight, the increased lachrymation, conjunctiva hyperaemia. For diagnostics of a blefarokhalazis fizikalny inspection, a vizometriya, biomicroscopy, a tonometriya, computer refractometry, perimetry is carried out. Tactics of treatment comes down to performance of the top blefaroplastika in combination with plasticity of a plaintive point and a resection of "fatty" hernias.
Blefarokhalazis – a pathological overhang of skin folds of upper eyelids. For the first time the disease was described in 1937 by the Australian ophthalmologist Ida Mann. Statistical data on the general prevalence of a disease are absent. Cases of development of anomaly at three generation of one family are described that allows to assume genetic predisposition to emergence of a blefarokhalazis. The disease most often comes to light at elderly women. Among patients persons of Caucasian race prevail that is caused by features gistoarkhitektonik of skin.
Reasons of a blefarokhalazis
The disease etiology is up to the end not known. As a rule, sporadic cases of a disease are observed. Omission of a century one of manifestations of a half atrophy of the person becomes more rare. Scientists study a role of vascular and endocrine factors. Pathology can develop against the background of angioneurotic hypostasis at patients with the burdened allergologichesky anamnesis. Main reasons for a blefarokhalazis:
- Specific features of a structure of skin. Persons with the reduced elasticity of integuments are subject to risk of developing of a disease. Hydrophilic properties of skin are defined by structure of an intercellular matriks and fibers of connecting fabric.
- Long hypostasis. Frequent hypostases of periorbitalny area are caused by pathology of kidneys (the chronic renal failure, glomerulonefrit), allergic reactions. Development of a disease is promoted by features of food (overconsumption of salt and liquid, proteinaceous starvation).
- Involutional changes century. With age at patients manifestations of a senile elastoz and atrophic changes of integuments accrue, the tone of a circular muscle of an eye decreases.
- Laffera-Asher's syndrome. At persons with this genetic syndrome besides a blefarokhalazis increase in a thyroid gland and a dublikatur of a mucous membrane of an upper lip is observed. The first symptoms come to light in awkward age.
- Application of accessories. The probability of developing of a disease significantly increases at application of piercing for a century, and also decor elements (pastes, spangles, false eyelashes). Drawing a permanent make-up exponentiates development of a blefarokhalazis only at allergic hypostasis.
- Yatrogenny influence. Violation of the technology of performance of cosmetology manipulations in okologlaznichny area can become a cause of illness. Bystry progressing of a blefarokhalazis is connected with carrying out laser rejuvenation of skin.
In the development mechanism the key part is assigned to involutional changes. Initial signs of aging come to light a century already from twenty-year age. According to morfogistologichesky researches, pathogenesis thinning of collagenic fibers in a combination with relative increase in volume of connecting fabric in structure of a circular muscle is the cornerstone. Among chaotically located fibers of collagen single elastichesky fibers are visualized. In many cases they completely are absent. Atrophic changes affect all layers of integuments. Application of accessories leads to stretching of skin and development of a unilateral form of pathology.
At patients with blefarokhalazisy process of neuromuscular regulation of a vascular tone is broken that conducts to a vazodilatation. Increase in inflow of blood and decrease in microcirculator pressure promotes progressing of chronic developments of stagnation. Only upper eyelids are usually involved in pathological process, however at application of specific methods of diagnostics secondary violations come to light also on skin of lower eyelids. Thinning of a tarzoorbitalny fastion becomes the reason of emergence of fatty "hernias". Atrophic changes are often combined with a chronic blefarit which aggravates a course of disease.
Symptoms of a blefarokhalazis
The first symptoms of a disease develop at persons of 20-40 years. The clinical picture is most brightly expressed at senile age. Patients note that emergence of symptomatology was preceded by hypostases a century or a chronic current of a blefarit. An early symptom of a disease – formation of the expressed skin fold on an upper eyelid during tension of mimic muscles (at a smile). It is most noticeable at observation of the person in a profile. Patients show complaints to a "meshkovidny" overhang of folds a century which partially or completely cover the top eyelashes. At the initial stages of patients exclusively cosmetic defect disturbs.
When progressing a blefarokhalazis pathological changes come to light even at rest. Skin becomes thinned, stretched, through it illuminate vessels. The specific protrusions reminding fatty "hernias" are visualized. Sight worsens at an overhang of integuments which close only a lateral corner of an eye in the beginning. At the complicated current the skin fold reaches the middle of a pupil. The irritation of skin eyelashes leads to their reddening and increase of hypostasis. Age changes of the auxiliary device of an eye lead to the strengthened dacryagogue, photophobia. Defeat century symmetric.
The most widespread complication of a blefarokhalazis – secondary blefarit. At most of patients the excessive overhang of skin promotes formation of an ektropion. Patients are subject to high risk of infectious defeats of forward department of eyes (conjunctivitis, keratit, blefarokonjyunktivit). Often it is possible to diagnose a kseroftalmiya. Pathological lachrymation provokes irritation of integuments in periorbitalny area. At a heavy current the ambliopiya develops. All patients with this disease in the anamnesis suffer from "a syndrome of a tired eye".
Fizikalny survey and tool methods of a research is applied to diagnosis. At visual survey the overhang of a century is defined. The direction of a fold – slanting, from medial edge to lateral. The outer edge of an eye crack is covered with the hung integuments. Elasticity of skin is reduced, through the thinned skin illuminate vessels. Specific methods of diagnostics include carrying out:
- Vizometriya. Decrease in visual acuity is observed only at the expressed overhang of a century. At test the patient blinks the eyes and tries to raise a skin fold.
- Computer refractometry. Patients have a secondary ambliopiya. Purpose of a research to patients of old age allows to diagnose a presbiopiya. The miopichesky type of a clinical refraction is found in persons up to 40 years more often.
- Eye biomicroscopy. At survey of a forward segment of eyes the injection of vessels of a conjunctiva and the single centers of an ulceration of a cornea caused by irritation of covers of eyeballs palpebralny edge and eyelashes comes to light.
- Perimetry. The technique gives the chance to diagnose uneven narrowing of the visual field. Top drop out of a field of vision, is more rare – verkhnelateralny sites. In some cases fotopsiya come to light.
- Contactless tonometriya. Violation of outflow of watery moisture provokes increase in intraocular pressure. At additional carrying out an electronic tonografiya minor changes of intraocular hydrodynamics are found.
Differential diagnostics in ophthalmology is carried out with blefaroptozy and blefarofimozy. Distinctive feature of a blefarofimoz is the combination of a ptoz to shortening and narrowing of an eye crack. Isolated it is caused by the miogenny or neurogenetic mechanism. The patient is incapable to open an eye crack independently. When forming during a century of the hanging skin and muscular fold it is about a psevdoblefarokhalazisa.
Treatment of a blefarokhalazis
Cosmetic correction of defect by means of a blefaroplastika is shown to patients with this disease. Surgery is carried out in out-patient conditions under regional anesthesia. The first stage of operation – removal of surpluses of integuments of a century with their further tightening. Patients with the increased lachrymation need additional plasticity of a plaintive point. For prevention of postoperative omission of a century to patients of advanced age carry out a kantopeksiya. If necessary carry out plasticity of a sinew of the muscle raising an upper eyelid. Detection of orbital hernias demands their resection. Removal of skin seams is made for 5-7 days after surgery. The modern method of elimination of a blefarokhalazis by means of a combination of microwave and laser radiation is at a development stage.
Forecast and prevention
The forecast at timely elimination of cosmetic defect favorable. Specific preventive measures are not developed, nonspecific are directed to observance of rules of hygiene of eyes. For prevention of a disease it is not necessary to carry a long time a make-up with specific elements of a decor on centuries (pastes, spangles). Ophthalmologists do not recommend to do piercing on centuries as under weight of accessories skin gradually stretches and loses former elasticity. Persons with early symptoms of a disease need to watch a food allowance and a condition of skin.