Ocular surface morbidity in eyes with senile sunken upper eyelids

Purpose: To report ocular surface findings in eyes manifesting senile sunken upper eyelids.

Design: Cross-sectional comparative case series.

Participants: A study group of 38 eyes of 38 patients with sunken upper eyelids was compared with a control group of 26 age- and gender-matched patients without sunken upper eyelids.

Methods: Patient records were retrieved and compared between the 2 groups and among different severities of sunken upper lids.

Main outcome measures: Ocular surface deficits were measured by symptoms, eyelid blinking and closure, Bell's phenomenon, apposition of lids and puncta to the globe, conjunctiva inflammation and chalasis, corneal epithelial breakdown by fluorescein and Rose Bengal staining, and the fluorescein clearance test.

Results: Ocular irritation or pain was less common, but tearing and mucous buildup were more common in the study group than the control group, and it tended to be worse in the morning. Incomplete blinking, incomplete closure, abnormal Bell's phenomenon, lid/punctum ectropion, and delayed tear clearance were more frequently detected in the study group than the control group and were more evident in severely affected eyes. Incomplete blinking was significantly correlated with incomplete closure, whereas abnormal Bell's phenomenon was significantly correlated with early morning symptoms. Conjunctivochalasis was less common in the study group than the control group. Corneal epithelial breakdown was more common in the study group than the control group, and was more severe in severely affected eyes.

Conclusions: Sunken upper eyelids are associated with ocular surface morbidity characterized by corneal epithelial breakdown because of an array of ocular surface deficits leading to exposure and desiccation, not only during the day but also in the night. Recognition of this potential risk factor will help to understand pathogenesis and formulate effective therapies in complex ocular surface diseases.

Financial disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.