Immunohistochemical characteristics and mechanisms of development of excessive eyelid laxity

Relevance Involutional deformations of the eyelids and surrounding areas are associated with physiological processes characteristic of tissue atrophy during aging in their etiology and pathogenesis. Blepharoplasty is most often performed to correct these changes in plastic ophthalmic surgery. In these cases, we most often perform free skin grafting [1]. However, along with the high demand for this operation, there have recently been more frequent cases of persistent secondary eyelid deformations, complications with the organ of vision, and, as a consequence, psychological problems in patients due to deterioration in appearance in the postoperative period. According to various data, HSV occurs in 0.5–31.5% of patients, their average age is 51 years [2–4]. Objective To identify immunohistochemical pathogenetic signs of hyperextensible eyelids with their involutional deformations. Material and methods The expression of elastolytic proteases MMP-7 and MMP-9, markers of local aseptic inflammation and damage to elastic fibers, was studied in 50 surgical biopsies of upper and lower eyelid tissues from 25 patients aged 41–65 years. Of these, 10 patients had eyelid hyperextensibility in blepharochalasis and eyelid tissue hyperelasticity, 4 patients had hyperextensible eyelid syndrome (HES), and the control group consisted of 11 patients with involutional eyelid deformities without signs of their hyperextensibility. Results A significant increase in the activity of elastolytic proteases MMP-7 MMP-9 with similar activity of these markers in true HES was found in the skin, orbicularis oculi muscle, tarsal plate, blood vessel walls, and meibomian glands of patients with blepharochalasis and eyelid tissue hyperelasticity. This was the main pathogenetic mechanism of destruction of elastin fibers, walls of blood vessels with deterioration of hemomicrocirculation of eyelid tissues both with hyperextensibility of the eyelids and with hyperextensibility syndrome. Conclusion On average, every fourth patient with involutional changes in the eyelids had morphological signs of hyperextensibility of the eyelids, it is advisable to identify them at the stage of planning blepharoplasty, to include them in the group of increased risk of complications, to use special blepharoplasty techniques aimed at strengthening the frame function of the eyelids. Key words: hyperextensible eyelid syndrome (HES); hyperextensible eyelids; blepharochalasis; eyelids; immunohistochemistry; elastolytic proteinases