The Histopathology and the Pathogenesis of Floppy Eyelid Syndrome

Abstract

Purpose : Floppy eyelid syndrome (FES) is an uncommon, but distressing condition, characterized by a constellation of symptoms and signs that include an easily everted upper eyelid, papillary conjunctivitis, nonspecific ocular irritation, and a rubbery, malleable eyelid. The pathogenesis of FES has not been fully elucidated. We performed an observational case series to further explore the pathogenesis of FES by studying the degree of association of adipose tissue accumulation, loss of elastic tissue, and scarring in the tarsus.

Methods : Twenty specimens of FES were obtained from the Ocular Pathology Registry of the University of Ottawa Sections from each formalin-fixed paraffin-embedded specimen were stained with hematoxylin and eosin, periodic acid-schiff stain, Masson’s trichrome, Verhoeff-Van Gieson elastica, and S100. Each slide was analyzed by light microscopy. Scores of 0 to 4+ were assigned for the number of adipocytes, amount of elastic tissue, and degree of fibrovascular scarring in the tarsus. In each specimen, the number of adipocytes can readily be counted, while the degree of changes in the elastic tissue and amount of fibrovascular scarring were compared to selected test slides. Specimens of eyelids with a normal tarsus served as controls. Furthermore, we evaluated the impact of age and gender on our results in both groups of patients.

Results : The number of adipocytes was significantly higher for the FES specimens compared to the controls (p <0.05). The amount of elastic tissue in the FES specimens were significantly lower and found to be mainly present around the Meibomian glands. There was increased fibrovascular scarring within the tarsus in the FES specimens compared to the controls.

Conclusions : Our study documents the presence of increased adipocytes, decreased elastic tissue, and the presence of fibrovascular scarring and their potential role in the pathogenesis of FES. Our results further characterizes the pathological processes involved in FES.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.