gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

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Pathogenesis of "Floppy Eyelid Syndrome" (FES): involvement of Matrix metalloproteinases in elastic fiber degradation

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  • corresponding author L. M. Holbach - Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen
  • M. Stoikovic - Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen
  • C. Cursiefen - Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen
  • C. Hofmann-Rummelt - Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen
  • F. E. Kruse - Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen
  • U. Schlötzer-Schrehardt - Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 006

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dog2004/04dog497.shtml

Published: September 22, 2004

© 2004 Holbach et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

To analyze eyelid biopsy specimens in patients with FES with special regard to elastic fiber content and ultrastructure as well as expression of elastin-degrading enzymes.

Methods

Horizontal pentagonal lid resections of 16 upper eyelids were performed in 11 patients with FES. Full thickness lid specimens and controls from 9 age-matched patients with basal cell carcinoma were studied by light and transmission electron microscopy, semiquantitative morphometry and immunohistochemistry using antibodies against matrix metalloproteinases 2, 7, 9 12 and neutrophil elastase.

Results

Histopathologic studies revealed a significant decrease of elastic fibers within the posterior (tarsus) and anterior eyelid lamella (skin) as compared to controls. Residual elastic fibers showed an abnormal ultrastructure with a diminished elastin core. Immunohistochemically, there was an increased immunoreactivity for elastolytic proteases (esp. metalloproteinases 7 and 9) in areas of elastin depletion.

Conclusions

Upregulation of elastolytic enzymes, most probably induced by mechanical stress, contributes to elastic fiber degradation with subsequent tarsal laxity and eyelash ptosis in patients with FES. Nocturnal eversion and poor contact of the lax eyelids with the globe my further enhance secondary keratoconjunctivitis.