J Korean Ophthalmol Soc.  2011 May;52(5):582-588. 10.3341/jkos.2011.52.5.582.

Histopathologic Properties of Eyelid Skin and Conjunctiva in Patients with Dermatochalasis

• Park JS
• Ha SW
• Lew H

• KMID: 2214578
• DOI: http://doi.org/10.3341/jkos.2011.52.5.582

Abstract

PURPOSE
To evaluate histopathologic properties of eyelid skin and conjunctiva and the association between clinical manifestation and histopathologic findings.
METHODS
A prospective study was conducted on the histologic findings of the upper eyelid skin and conjunctiva performed from November 2009 to February 2010 in 27 patients for upper eyelid blepharoplasty procedures. Histopathologic studies were performed for specimens collected from the upper eyelid skin and inferotemporal bulbar conjunctiva. Preoperative photographs of the upper eyelid and conjunctiva were taken to grade clinical severity of dermatochalasis and conjunctivochalasis.
RESULTS
Decrease of collagen density and elastic degeneration in the eyelid skin and conjunctiva were significantly associated with aging (p < 0.001, p = 0.001, p = 0.001, p < 0.001). Clinical severity of dermatochalasis was correlated with a decrease of collagen density and elastic degeneration in the eyelid skin, and clinical severity of conjunctivochalasis was associated with a decrease of collagen density, elastic degeneration and lymphangiectasia in conjunctiva (p < 0.001).
CONCLUSIONS
Change of collagen fiber and elastic fiber in the eyelid skin and conjunctiva was observed with aging. Relaxation of the eyelid skin and conjunctiva was correlated with histologic findings.

Keyword

Collagen; Conjunctivochalasis; Dermatochalasis; Elastic fiber

MeSH Terms

Aging
Blepharoplasty
Collagen
Conjunctiva
Elastic Tissue
Eyelids
Humans
Prospective Studies
Relaxation
Skin
Collagen

Figure

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  Figure 1. Clinical severity score of dermatochalasis. (A) Grade 1, hanging skin margin above the upper eyelid skin margin. (B) Grade 2, hanging skin margin on the lid margin. (C) Grade 3, hanging skin margin below the lid margin.

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  Figure 2. Histopathologic findings of the eyelid and conjunctiva. (A) Histologic findings of the upper eyelid skin (Hematoxylin-eo-sin stain, ×50). Black arrow indicates epidermis, dotted arrow indicates dermis and gray arrow is subcutaneous fat. (B) Histologic findings of the conjunctiva (Hematoxylin-eosin stain, ×100). Black arrow indicates epithelium, dotted arrow indicates substantia propria and red arrow denotes lymphangiectasia.

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  Figure 3. Collagen density of the upper eyelid skin and conjunctiva. (A, B, C) Collagen density of upper eyelid skin (Trichrome stain, ×400). (A) Grade 3, high collagen density. (B) Grade 2, moderate collagen density. (C) Grade 1, low collagen density. (D, E, F) Collagen density of conjunctiva (Trichrome stain, ×400). (D) Grade 3, high collagen density. (E) Grade 2, moderate collagen density. (F) Grade 1, low collagen density.

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  Figure 4. Elastic degeneration of upper eyelid skin and conjunctiva. (A, B, C) Elastic degeneration of the upper eyelid skin (Verhoeff Van Gieson stain, ×400). (A) Grade 1, mild elastic degeneration. (B) Grade 2, moderate elastic degeneration. (C) Grade 3, severe elastic degeneration. (D, E, F) Elastic degeneration of the conjunctiva (Verhoeff Van Gieson stain, ×400). (D) Grade 1, mild elastic degeneration. (E) Grade 2, moderate elastic degeneration. (F) Grade 3, severe elastic degeneration.

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  Figure 5. Association between age and histologic findings of the eyelid and conjunctiva in dermatochalasis patients. Collagen density & elastic degeneration were significantly correlated with age regarding histologic findings of the eyelid skin and conjunctiva. Lid collagen density (p ＜ 0.001) and conjunctival collagen density (p = 0.001) noted to decrease according to age. Lid elastic degeneration (p = 0.001) and conjunctival elastic degeneration (p ＜ 0.001) were noted to decrease according to age.

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  Figure 6. Association between severity of dermatochalasis and conjunctivochalasis. Clinical severity of dermatochalasis tends to be related proportionally with the severity of conjunctivochalasis.

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  Figure 7. Association between clinical severity of dermatochalasis and conjunctival lymphangiectasia. Clinical severity of dermatochalasis is significantly associated with presence of conjunctival lymphangiectasia (p = 0.01).

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  Figure 8. Associations of histologic findings between eyelid skin and conjunctiva in the dermatochalasis patients. (A) Collagen density between the eyelid skin and conjunctiva is not significantly associated (p = 0.396), (B) eyelid skin elastic degeneration is significantly related to conjunctival elastic degeneration (p = 0.026).

Reference

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