Eyelid aging: pathophysiology and clinical management.

Renato Wendell Damasceno,Georgia Avgitidou,Rubens Belfort Jr,Leonard M Holbach,Paulo Elias Correa Dantas,Ludwig M Heindl

doi:10.5935/0004-2749.20150087

Abstract

Life expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

Highlights

As life expectancy increases worldwide(1), involutional and chronic eye diseases are becoming increasingly important in the spectrum of ophthalmological diseases
The involutional changes that result in eyelid pathology include ectropion and entropion, dermatochalasis, and aponeurotic ptosis
The prevalence of involutional ectropion and entropion increases with the patient’s age[12], which is the logical order for involutional malformations to increase with age[13]

Summary

INTRODUCTION

As life expectancy increases worldwide (about 600 million people are aged 60 years and older)(1), involutional and chronic eye diseases are becoming increasingly important in the spectrum of ophthalmological diseases. Two large study populations were chosen for these studies: The Rotterdam study included 5578 individuals of North European origin with an average age of 67 years living in the periphery of Rotterdam and the UK twins study involved 2186 twins with an average age of 53 years living in Great Britain[8] By studying these populations, many non-genetic risk factors for sagging eyelids could be discerned, including age, high body mass index, lighter skin color, smoking, male gender, and heritability[8]. The literature suggests that the preva lence of ectropion is about 4% in patients older than 49 years, not differing among the different ectropion forms or regarding the underlying etiology[12,13] This involutional malformation is the most common form of ectropion and entropion[14]. The prevalence of involutional ectropion and entropion increases with the patient’s age[12], which is the logical order for involutional malformations to increase with age[13]

Pathogenesis and pathological findings

Clinical findings

Findings

Surgical management