OBJECTIVE

To analyze immunohistochemical features of hyperextensible eyelids and floppy eyelid syndrome (FES) following involution-related deformities.

MATERIAL AND METHODS

We estimated expression of proteases MMP-7 and MMP-9 (markers of local aseptic inflammation and elastic fiber damage) in 50 specimens of upper and lower eyelid tissues (skin, circular eye muscle, and tarsal plate) harvested from 25 patients aged 41—65 years. Of these, 10 patients (20 biopsies) had hyperextensible eyelids following blepharochalasis and tissue hyperelasticity, 4 patients (8 biopsies) — FES. The control group consisted of 11 patients (22 biopsies) with involution-related eyelid deformities and no signs of hyperextensibility.

RESULTS

We found significantly higher activity of proteases MMP-7 and MMP-9 with similar activity of these markers in FES in skin, circular muscle of the eye, tarsal plate, vascular walls and meibomian glands in patients with hyperextensible eyelids with blepharochalasis and tissue hyperelasticity. This was the main mechanism of destruction of elastin fibers and vascular walls with deterioration of microcirculation in eyelid tissues in both hyperextensible eyelids and FES.

CONCLUSION

Pathogenetic mechanisms of hyperextensible eyelids following blepharochalasis, tissue hyperelasticity and FES are similar and include degradation of collagen and elastin in eyelid skin, circular eye muscle, tarsal plate, meibomian glands and palpebral conjunctiva, as well as lesion of microcirculatory vessels followed by chronic inflammation with impaired blood supply. Every fourth patient with eyelid involution had morphological signs of hyperextensible eyelids. It is reasonable to identify these patients at the stage of blepharoplasty planning, refer to the group with high risk of complications and use special blepharoplasty techniques for eyelid reinforcement.