A variety of conditions can cause the appearance of “baggy eyes.” This condition is, to some extent, almost inevitable if we live long enough. Severe cases of baggy eyes, however, are often caused either by Blepharochalasis or Dermatochalasis. Although they are sometimes confused, these are two distinct conditions that present different symptoms and affect different segments of the population.

How Blepharochalasis Causes Your Baggy Eyes
Blepharochalasis is a fairly rare condition that usually strikes children sometime around puberty, although cases involving adults are not unheard of. It was given its name in 1896 by influential ophthalmologist Dr. Ernst Fuchs, who took the name from the Greek words for eyelid (blepharo) and slackening (chalasis). A person suffering an advanced and untreated case of blepharochalasis will have the appearance of baggy eyes—loose, folded skin on the eyelids that would ordinarily be seen only with much older people. Blepharochalasis can be bilateral (affecting both eyes) or unilateral (affecting only one eye). Blepharochalasis sufferers experience regular but unpredictable “attacks,” during which their eyelids become badly swollen. These attacks sometimes last as little as two hours, but the usual duration is about two days.

The upper eyelids are usually affected, although in some cases the lower eyelids may also swell up. The cumulative effect of these attacks is that the skin around the eyes loses its elasticity, becomes thin, wrinkled, and discolored, and eventually atrophies. (Describing the condition he had named, Dr. Fuchs said the skin around the eyes eventually begins to resemble cigarette paper.) Blepharochalasis can eventually lead to other complications besides baggy eyes, including ptosis, proptosis, lower lid retraction, and the formation of pseudoepicanthal folds. The swelling characteristic of blepharochalasis is believed to be caused by the rapid buildup of fluid or fat in the tissues surrounding the eye. Most cases are idiopathic, however, meaning that the cause of the fluid accumulation is unknown—although it has been linked to a congenital kidney condition known as renal agenesis, in which the kidneys develop abnormally in the womb. The fact that the disease strikes around puberty has led some experts to suggest that it results from an endocrine imbalance.

Blepharochalasis must be allowed to run its course before the baggy eyes it causes can be treated, usually with blepharoplasty or some similar surgery. Some progress toward better treatment has been made in recent years, however, and in 2007 the National Center for Biotechnology Information and the National Institute of Health described the case of a 57-year-old man whose blepharochalasis-related swelling was successfully reduced with an oral medication called acetazolamide.

How Dermatochalasis Causes Your Baggy Eyes
In contrast to blepharochalasis, dermatochalasis tends to strike the elderly rather than the young (although it can sometimes appear in patients as young as 40), and its causes are better understood.

Dermatochalasis is generally caused by gravity and by age, which brings a loss in skin elasticity and a weakening of the connective tissue around the eyelid. Like blepharochalasis, dermatochalasis causes the appearance of baggy eyes, although it is generally less severe and the problem it presents is more cosmetic than functional. Most people with dermatochalasis simply learn to live with it, regarding it as just another sign of their advancing age. In some cases, however, dermatochalasis can affect the vision and must be treated. In these cases, the eyelid may begin to droop into the field of vision, making it difficult for the subject to read, drive, or perform any number of other routine activities.

Some people may develop a habit of constantly raising their eyebrows to improve their visual field, and this can cause chronic headaches. Other problems that can arise as a result of severe dermatochalasis include irritation of the eye, dry eye, entropion (inward turning of the upper eyelid), ectropion (outward turning of the lower eyelid), dermatitis, and blepharitis. As with blepharochalasis, dermatochalasis is most often treated with blepharoplasty surgery. If the patient’s age is particularly advanced and the dermatochalasis is not causing problems with vision, there may be no reason to treat the condition at all, unless the patient is concerned about the cosmetic appearance of baggy eyes. Some patients may have concerns about looking older, and may wish to have surgery performed for this reason alone.

Although dermatochalasis is not always entirely preventable, it can certainly be delayed at the very least. Take care of your skin—do not over-wash your face, and frequently use moisturizing cream to prevent excessive dryness. Do not smoke or drink excessively, and try to avoid spending too much time in the sun.

Questions to Ask Your Doctor About Baggy Eyes

  • I have been experiencing swelling of my eyelids; is this a sign of blepharochalasis?
  • How soon can surgery be performed to correct the damage to the appearance of my eyelids?
  • Are my baggy eyes being caused by blepharochalasis, dermatochalasis, or something else?
  • Am I likely to experience dermatochalasis as I grow older?