Pathomorphologic features of the structure of hyperextensible eyelid tissues

Purpose of a study: to identify pathomorphological features of hyperextensible eyelids for planning and predicting the outcome of blepharoplasty.

Material and methods. 352 patients (100%) with involutional eyelid changes, indications for aesthetic blepharoplasty were examined. Out of the total number of the study participants 87 patients (24.7%) had clinical signs of hyperextensible eyelids (HES): ‘festoons’, hypotonia of the lower eyelids with positive ‘pinch test’, pronounced skin folds and free easy displacement of lax tissues of eyelids, face and neck, pseudoblepharochalasis, ptosis of eyebrows, dystopia of the external corners of the eyes and risk factors of postoperative eyelid retraction. We analysed surgical biopsies of the skin, circular muscle of the eye, and tarsal plate after blepharoplasty operations from 28 patients aged from 41 to 60 years with clinical manifestations of HES combined with hyperelastosis (17 patients) and blepharochalasis (11 patients).

Results. Typical morphological signs of hyperextensibility of the eyelid skin, circular muscle of the eye, and tarsal plate have been established: sclerosis, focal dystrophy of the intercellular substance, moderate macrophagelymphocytic infiltration with eosinophils markers of chronic inflammation, and necrosis of adipocytes and meibomian glands. In HES in eyelid skin elastic fibres are registered in small quantity, fragmented, single with signs of destruction; in blepharochalasis they are absent; collagen fibres are significantly thinned, which leads to a decrease in elasticity, tone and turgor of the skin.

Conclusion. Morphological changes in tissue structure in HES combined with blepharochalasis and hyperelasticity directly correlate with clinical manifestations of HES. It is advisable to identify such patients at the stage of blepharoplasty planning, classify them as a risk group for secondary postoperative deformities and apply to them gentle blepharoplasty techniques with elements of eyelid strengthening.

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