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Visual‐field loss caused by excessive dermatochalasis due to solar elastosis

We present a patient with dermatochalasis of both upper eyelids, causing visual-field loss recovery after blepharoplasty. A 65-year-old man with bilateral blurred vision and droopy upper eyelids for at least 5 years was referred to our clinic. His best corrected visual acuity was discernment of hand motions at a distance of 1 m using the left eye and 5 ⁄ 10 (Snellen s chart) in the right eye. On physical examination, he had marked droopiness of both upper eyelids, which were more pronounced temporally with prominent folds (Fig. 1a,b). The skin of the eyelids and forehead region was thickened and poorly adherent to the underlying tissue. Superficial yellowish papules were present on the neck, with sparing of the flexural areas. The levator muscle functions and extraocular motility were normal. Biomicroscopical examination was normal in the left eye and revealed cataract formation in the right. Retinal examination revealed macular atrophy in the left eye and alterations of retinal pigment epithelium in the macular region in the right eye. No leakage was found in the left eye by fundus fluorescein angiography. Goldman kinetic visual-field examination showed a peripherally restricted right visual field with upper temporal field defect fusing with the blind spot. A confrontation visual-field examination was performed. The defects bilaterally corresponded to the clinical configurations of the eyelid positions. We considered the possibility of a systemic disorder such as pseudoxanthoma elasticum (PXE) or other elastic-tissue syndromes, due to the presence of superficial yellowish papules in our patient. There was no family history of similar skin lesions. The patient was referred to the dermatology department for his skin lesions but no systemic findings attributable to PXE were found, and retinal examination did not reveal angioid streaks. He was referred for oculoplastic consultation regarding surgical correction and later underwent blepharoplasty. After surgery, the patient showed dramatic improvement in his visual fields and the position of the upper eyelids was normal (Fig. 1c,d).