Blepharochalasis with Double Upper Lip

128

NOTES, CASES, INSTRUMENTS

ciliary body frequently occurs at its attachment and an entire separation of it from the sciera may take place. Hemorrhage into the vitreous body follows. The aphakia produced results from the luxation of the lens into the vitreous or the subconjunctival space. The lens may be expelled. More rarely, subluxation is preceded by iridodialysis and laceration of the zonular fibers. The lens moves in front of the ciliary body and through the iris coloboma toward the place of rupture. Here, because of its size or the insufficient force, it may become incarcerated in the wound. Prognosis. Added to the severity of such traumatic lesions is the danger of subse-

quent infection. Most eyes which have suffered a rupture, undergo destruction. It is the exception, in fact, for such an injury to recover with retention of serviceable vision. Further complications include the onset of secondary glaucoma, detachment of the retina, and sympathetic ophthalmia. SUMMARY

A case of incomplete subconjunctival dislocation of the lens is presented in which recovery with useful vision ensued. The mechanism of the injury is briefly described and the prognosis stated. 6 North Michigan Avenue

(2).

REFERENCE

1. Fuchs, E. : Textbook of Ophthalmology (Duane). Philadelphia, Lippincott, 1923, p. 812.

BLEPHAROCHALASIS W I T H DOUBLE U P P E R L I P LESTER W.

EISENSTODT,

M.D.

Newark, New Jersey

Fig. 1 (Eisenstodt). Preoperative photograph showing atrophie superfluous folds of skin hanging over the eyelid margins. Reduplication of the upper lip was evident only when the patient smiled.

Blepharochalasis is a chronic disease of both upper eyelids in which repeated sudden attacks of severe edema occurs. The essential factors in the etiology and pathogenesis are unknown. It is probably a cutaneous manifestation of some constitutional disease. The condition was first described by Fuchs 1 who believed its etiology was on an angioneurotic basis. Alvis2 made an exhaustive study of the literature and defined blepharochalasis as a "chronic or recurring edema of the eyelids resulting in a laxity of the lid tissues with dilation of the vessels, thinning, wrinkling and discoloration of the skin, with finally a prolapse of orbital fat and the tear glands and a drooping of the lids." Alvis concluded that the only successful treatment was a surgical excision of the flabby skin. He also found that Ascher,3-4 Wirth, 5 and Eigel6 described the condition as associated with

NOTES, CASES, INSTRUMENTS

129

a double upper lip. Gifford7 believes "that some peculiar disorder of the vasomotor system is responsible." It is the purpose of this paper to describe another case of blepharochalasis with a double upper lip. CASE REPORT

History, R. G., a boy, aged 13 years, was referred for the cosmetic correction of his deformed eyelids. His history showed that, at the age of 7 years, he sustained a blow on the back of the head. Upon awakening the next morning, he found his upper eyelids severely swollen. After a period of time, the edema partially subsided. Since that time, several other sudden attacks have occurred periodically at 6 to 12-month intervals with diminishing resolution of the edematous skin. His mother stated that she has taken the patient to several clinics for diagnosis and treatment. No physiochemical, allergic nor endocrine disfunction was found and no specific therapy was advocated. Examination revealed a well-developed young man. The skin of both upper eyelids was very soft, loose, atrophie, reddish-purple in color, and superfluous, hanging in a fold over the lid margins (fig. 1). In order to see, the patient was forced to hold his head tilted backward. The redundant skin was easily picked up and pinched between the fingers. A very prominent double upper lip, due to a duplication of the sublabial mucous membrane, was noted. The superfluous mucous membrane was only evident when the patient smiled. It was deemed advisable to excise the excess skin of the eyelids both for functional and cosmetic reasons. Local anesthesia was not employed since it would further balloon out the atrophie skin. Under sodium pentathol anesthesia, a large eliptical section of skin was excised from the superior palpebral sulcus to conceal the resulting scar. The extensive resulting defect was repaired by careful approximation of the

Fig. 2 (Eisenstodt). Postoperative photograph taken 13 months later after another attack of edema.

margins with multiple interrupted fine Dermalon sutures. The superfluous mucous membrane causing the duplication of the upper lip was also excised and the wound closed directly with multiple interrupted sutures. A pressure dressing was applied to both eyelids and the upper lip for three days. The patient made an uneventful recovery and the cosmetic end result was quite satisfactory. The upper eyelids, however, retained their reddish pigmentation. After approximately four months, the abnormal pigmentation disappeared and the color of the eyelids blended with the surrounding structures. At this time, it was noted that the mucous membrane of the upper lip had again become redundant. It was subsequently excised under block anesthesia. The patient's course was smooth and uneventful until exactly one year after the eye-

130

NOTES, CASES, INSTRUMENTS

compresses, the swelling rapidly regressed. The skin of the eyelids, however, did not undergo complete resolution and additional thinning and edema were noted (fig. 2). Examination also revealed the mucous membrane of the upper lip to be swollen. The following year two additional attacks occurred resulting in a reformation of the double-lip deformity and further atrophy of the skin of the eyelids (fig. 3). After an additional period of observation, further plastic surgery will be performed on the eyelid and lip. CONCLUSIONS

Fig. 3 (Eisenstodt). Taken 16 months after Figure 2, during an acute attack of edema. Note the sympathetic mild edema of the lower eyelids.

lid operation. He awakened one morning to discover another attack of severe edema of the eyelids with no other subjective reactions. Under Pyribenzamine therapy and ice

1. A case of blepharochalasis with a double lip has been described. 2. The esthetic and functional end results of surgical correction of blepharochalasis were satisfactory but did not prevent further edematous attacks. 3. Excision of the superfluous mucous membrane causing the double lip deformity was twice performed with only a temporary satisfactory result. 4. It seems logical to conclude that, in this instance, a physiologic relationship exists between blepharochalasis and the double lip deformity. 31 Lincoln Park

(2).

REFERENCES

1. Fuchs, E. : Textbook of Ophthalmology, Duane translation, 1901, p. S53. 2. Alvis, B. Y. : Blepharochalasis : Report of a case, Am. J. Ophth., 18:238-246, 1935. 3. Ascher, K. W. : Blepharochalasis mit Struma und Schleimhautduplicatur der Oberlippe. Klin. Monatsbl. f. Augenh., 65:86,1919. 4. : Klin. Wchnschr., 1:2287, 1922. 5. Wirth: Ztschr. f. Augenh., 44:176,1920. 6. Eigel, W. : Blepharochalasis und Doppellippe, ein thyreotoxisches Oedem ? Deutsche med. Wchnschr., 47:1947, 1925. 7. Gifford, S. R. : A Textbook of Ophthalmology, Philadelphia, Saunders, 1941, p. 105.

H E R P E S ZOSTER

OPHTHALMICUS

A CASE WITH MANIFOLD COMPLICATIONS MORRIS H.

PINCUS,

M.D.

Brooklyn, New York

Herpes zoster ophthalmicus is comparatively uncommon. The occurrence of oph-

thalmic zoster with manifold ocular complications in a single instance is rare. CASE REPORT

History. Mr. A. S. G., aged 45 years, who had been in excellent health, was awakened from sleep during the early morning hours of July 1, 1946, with a sharp pain deep in,