Steatoblepharon is the anterior prolapse of eyelid fat pad, due to weakening of orbital septum, resulting in a puffy appearance of the eyes. The eyelid fat pads play an important role in maintaining contour of eyelids. Eyelid fat provides fullness and smoothness to both upper and lower eyelids. Instead of prolapse, atrophy of eyelid fat may cause posterior sinking of eyelids resulting in involutional enophthalmos.
The upper eyelid contains two fat pads located in medial and central compartment. The lower eyelid contains three fat pads located in medial, central and lateral compartments.
In younger individuals, steatoblepharon may be seen as a familial condition. But in most of the cases, it is seen as an involutional phenomenon associated with eyelid laxity or dermatochalasis.
Patients present for cosmetic reasons.
There is fullness of eyelids due to prolapsed orbital fat.
Steatoblepharon may be a familial condition in younger individuals, and is not associated with signs of ageing.
In most cases, steatoblepharon is due to involutional process, associated with laxity of eyelids or dermatochalasis.
Excessive steatoblepharon may be associated with systemic disease such as Graves’ ophthalmopathy, where fat is increased in volume and may also be oedematous.
In the upper eyelid, the medial fat pocket is typically most prominent. Bulging in the lateral part of upper lid is primarily due to prolapsed lacrimal gland.
Steatoblepharon usually is associated with dermatochalasis and may be obscured by overhanging skin fold in upper eyelid.
In the lower eyelid, fat may be prolapsed in any of the three compartments. There may be two fat pockets or even one contiguous pocket. The lateral fat pocket is typically most prominent, but fat prolapse may involve medial and central fat pockets with a bulge across entire lower eyelid.
Management is primarily surgical. It is often combined with blepharoplasty.
For mild fat prolapse, orbital septum may be tightened.
For significant degrees of fat prolapse, orbital septum is opened and fat pocket is cauterised and excised.
In lower eyelid steatoblepharon without dermatochalasis, fat pockets are removed through a trans-conjunctival incision, without disturbing the orbital septum.
In cases with excess skin in lower eyelid, a trans-cutaneous incision is preferred, and the skin is tightened laterally.
Repositioning of fat beneath the descended malar fat pad may also be done.