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A 20-year-old woman presented with drooping of both the eyelids (left>right). She had intermittent upper eyelid oedema for 3 years. There was no diurnal variation or fatiguability. The neuro-ophthalmic examination was normal including the extraocular movements. Serum anti-acetylcholine receptor antibodies, CT of the orbit and electromyography were unremarkable. Loose overhanging skin changes were highlighted on clinical reassessment (figure 1A). Atrophy of nasal fat pad causing ‘pseudo-epicanthic fold’ was noted (figure 1B). A diagnosis of blepharochalasis was confirmed on histopathology by demonstrating markedly reduced elastic fibres in the dermis (figure 2). Oral doxycycline (200 mg/day) in combination with topical tacrolimus 0.1% gel was given for 3 months with partial improvement. She disregarded a future plan of blepharoplasty.
Contributors MRT, DD and AT have equally contributed to the clinical diagnosis and management of the patient. DC has made the tissue diagnosis of the skin biopsy and reviewed the histological description of the photomicrograph. MRT has drafted the manuscript. DD and AT have critically revised the manuscript. All the authors have approved the final manuscript for submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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