Histopathologic Features of the Floppy Eyelid Syndrome: Involvement of Tarsal Elastin

Peter A. Netland, Stephen P. Sugrue, Daniel Albert, John W. Shore

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Purpose: Patients with the floppy eyelid syndrome have chronic papillary conjunctivitis with easily everted upper eyelids and a soft, pliant upper tarsus. The purpose of this study is to describe the clinical features and the histopathologic correlate in a group of patients with floppy eyelid syndrome. Methods: The authors examined eight patients with floppy eyelid syndrome, four of whom underwent surgical management with horizontal eyelid shortening. Eyelid tissue from these patients was examined using light microscopy, electron microscopy, and immunohistochemistry and compared with controls with unrelated eyelid or orbital disorders. Results: Clinical findings included obesity or eye rubbing, lash ptosis, and, less commonly, blepharoptosis. Two patients had documented sleep apnea with abnormal sleep electroencephalogram. Light microscopy of the surgical specimens showed chronic conjunctival inflammation, papillary conjunctivitis, and meibomian gland abnormalities, including granuloma formation. Verhoeff's modified elastin stain demonstrated a marked decrease in the amount of elastin fibers in tarsus from patients with floppy eyelid syndrome compared with controls. Immunohistochemical staining for elastin also showed a marked decrease of tarsal elastin in floppy eyelid patients compared with controls. In contrast, immunohistochemical stains showed that the distribution of collagen types I and III was similar between patients with floppy eyelid syndrome and controls. Electron microscopy demonstrated that tarsal collagen was comparable in patients and controls, and that there was a reduced amount of tarsal elastin in floppy eyelid syndrome compared with controls. Conclusions: These findings demonstrate that tarsal elastin is decreased in the floppy eyelid syndrome, which may contribute to the laxity of the tarsus in this disorder.

Original languageEnglish (US)
Pages (from-to)174-181
Number of pages8
JournalOphthalmology
Volume101
Issue number1
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

Fingerprint

Elastin
Eyelids
Ankle
Conjunctivitis
Microscopy
Electron Microscopy
Coloring Agents
Meibomian Glands
Blepharoptosis
Light
Collagen Type III
Sleep Apnea Syndromes
Collagen Type I
Granuloma
Electroencephalography
Sleep
Collagen
Obesity
Immunohistochemistry

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Histopathologic Features of the Floppy Eyelid Syndrome : Involvement of Tarsal Elastin. / Netland, Peter A.; Sugrue, Stephen P.; Albert, Daniel; Shore, John W.

In: Ophthalmology, Vol. 101, No. 1, 01.01.1994, p. 174-181.

Research output: Contribution to journalArticle

Netland, Peter A. ; Sugrue, Stephen P. ; Albert, Daniel ; Shore, John W. / Histopathologic Features of the Floppy Eyelid Syndrome : Involvement of Tarsal Elastin. In: Ophthalmology. 1994 ; Vol. 101, No. 1. pp. 174-181.
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