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August 30, 1976

Chronic Severe Periorbital Edema

Author Affiliations

University of Colorado Medical Center Denver

JAMA. 1976;236(9):1013. doi:10.1001/jama.1976.03270100015015

To the Editor.—  The 25-year-old man cited by Stanley Marcus, MD (235:2019, 1976) as having chronic recurrent bilateral periorbital edema since 5 years of age may indeed have true blepharochalosis,1 an autosomal dominant condition in which recurrent temporary lid swelling leads to loose folds of violaceous, somewhat atrophic eyelid skin. The recurring attacks of edema often cause attenuation and disinsertion of the levator aponeurosis from the upper tarsus, resulting in ptosis. Moderate or large levator resections by conventional techniques, without regard for the fact that the muscle is intact and of normal strength, will often result in severe overcorrection of the ptosis. Lid surgery should be directed at reinsertion of the levator aponeurosis in a controlled fashion under local anesthesia, as advocated by Drs Jones and Wobig.2