Recurrent ptosis in a patient with blepharochalasis: clinical and histopathologic findings

A 37-year-old woman presented with right upper eyelid blepharochalasis with ptosis. Right upper eyelid edema had occurred 2 to 3 times per year by 30 years old, although the frequency decreased with age. The edema occurred spontaneously and resolved within 1 to 2 days. She underwent a right levator tucking surgery at 22 years old, and the ptosis recurred 2 years postoperatively. She again underwent ptosis surgery with skin excision at 37 years old. The intraoperative findings showed a thin levator aponeurosis. The white line was therefore advanced to the upper tarsal edge, resulting in an appropriate height and curvature. Three months later, the patient's eyelid height was 1.5 mm higher with a little temporal peaking. The levator aponeurosis was histopathologically shown to contain many capillaries. The increased vascularity of the levator aponeurosis may contribute to recurrent bouts of edema resulting in stretching and disinsertion of the aponeurosis.