Abstract
BackgroundFloppy eyelid syndrome is a disorder in which the tarsal plate is easily distensible and is currently treated with conservative or surgical measures. Human tarsal plate contains type I collagen, which is crosslinked in corneal tissue as a treatment for keratoconus. We hypothesized that collagen crosslinking would similarly stiffen tarsal plate tissue and investigated this in porcine and human tarsal plate specimens.MethodsRiboflavin-sensitized porcine and human tarsus samples were irradiated with ultraviolet-A light. Porcine experiments were analyzed with gross photographs, anterior segment optical computed tomography (AS-OCT) imaging, and tensile testing. A prospective study of human tarsus was performed on samples from patients undergoing wedge resection for floppy eyelid syndrome and was analyzed with AS-OCT and tensile testing.Results73 porcine adnexa and 9 patients (16 eyelids) who underwent wedge excision were included in the study. Grossly, greater stiffness was observed in crosslinked porcine tissue. AS-OCT imaging in porcine tissue showed a distinct hyperreflective band in crosslinked specimens whose area and intensity increased with longer treatment time (P = 0.003); this band was also visible in crosslinked human specimens. Tensile testing was performed, but results were not statistically significant.ConclusionsAS-OCT imaging, which has not been previously described for tarsal plate, showed a characteristic change in crosslinked porcine and human specimens. Tissue stiffness was increased grossly, but changes in tensile properties were not statistically significant. Further study is warranted to determine relevance as a potential treatment for floppy eyelid syndrome.
Highlights
Floppy eyelid syndrome is a disorder in which the tarsal plate is distensible and is currently treated with conservative or surgical measures
Gross photographs taken before and after crosslinking showed a clear change in tissue stiffness, with greater stiffness of treatment specimens as compared to control specimens (Fig. 1)
Altogether, our results imply efficacy of tarsal crosslinking in increasing stiffness in both porcine tarsus and human tarsus from Floppy eyelid syndrome (FES) patients
Summary
Floppy eyelid syndrome is a disorder in which the tarsal plate is distensible and is currently treated with conservative or surgical measures. Human tarsal plate contains type I collagen, which is crosslinked in corneal tissue as a treatment for keratoconus. We hypothesized that collagen crosslinking would stiffen tarsal plate tissue and investigated this in porcine and human tarsal plate specimens. Floppy eyelid syndrome (FES) is a disorder in which the upper eyelids are lax and distensible and was first described by Culbertson and Ostler in 1981 [1]. Many pathologic changes in FES eyelids have been described, and nocturnal mechanical trauma and eye rubbing are thought to play a role, it remains unclear if these are the primary etiological factors in the development of FES [1, 4]. Pressure induced eyelid ischemia and systemic reperfusion oxidation injury during sleep may contribute to the degenerative changes seen [6, 7]
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