Acute episode of eyelid oedema

[...]CT orbits showed normal globes, extraocular muscle bulk and insertions and optic nerves. [...]a diagnosis of blepharochalasis was determined based on a history of recurrent, self-limited episodes of painless bilateral eyelid oedema beginning in adolescence. [...]in the active/early stage, blepharochalasis is believed to be unresponsive to steroids and antihistamines. 1-3 A case report series suggests that a combination of systemic acetazolamide and topical hydrocortisone relieves symptoms, decreases the incidence of occurrences and shortens episodes. 4 5 Surgery is the primary treatment for blepharochalasis, but it is not curative. 1 3 Moreover, surgery is not recommended until attacks have remitted for at least 6 months because recurrence of oedema can ruin previously good surgical results. 6 7 Discussion Blepharochalasis is a rare eyelid disorder of unknown pathogenesis characterised by recurrent episodes of painless upper and sometimes lower lid oedema that eventually lead to atrophic, lax and discoloured skin. 1 It affects genders equally with initial onset typically in adolescence, with declining frequency with increasing age. 1 Numerous triggers have been described such as menstruation, emotional stress and upper respiratory infection, although not all cases are associated with a trigger. 3 7-9 Blepharochalasis can be classified as having an active/early stage with ongoing attacks of oedema and findings of orbital septal weakness, prolapse of orbital fat, thinning and atrophy of the skin and eyelid tissues with characteristic 'wrinkled cigarette paper' appearance, telangiectasias, 6 ptosis and generalised laxity of the eyelid skin 7 between attacks.