HISTOPATHOLOGIC FEATURES OF THE FLOPPY EYELID SYNDROME - INVOLVEMENT OF TARSAL ELASTIN

Purpose: Patients with the floppy eyelid syndrome have chronic papilla ry conjunctivitis with easily everted upper eyelids and a soft, pliant upper tarsus. The purpose of this study is to describe the clinical f eatures and the histopathologic correlate in a group of patients with floppy eyelid syndrome. Methods: The authors examined eight patients w ith 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 immunohi stochemistry and compared with controls with unrelated eyelid or orbit al disorders. Results: Clinical findings included obesity or eye rubbi ng, 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 infl ammation, papillary conjunctivitis, and meibomian gland abnormalities, including granuloma formation. Verhoeff's modified elastin stain demo nstrated a marked decrease in the amount of elastin fibers in tarsus f rom patients with floppy eyelid syndrome compared with controls. Immun ohistochemical staining for elastin also showed a marked decrease of t arsal elastin in floppy eyelid patients compared with controls. In con trast, immunohistochemical stains showed that the distribution of coll agen types I and III was similar between patients with floppy eyelid s yndrome and controls. Electron microscopy demonstrated that tarsal col lagen was comparable in patients and controls, and that there was a re duced 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 t he laxity of the tarsus in this disorder.