Abstract

Purpose: Upper eyelid shortening is the main surgical procedure performed to avoid nocturnal eversion of this structure in floppy eyelid syndrome (FES). The efficacy of surgery for this condition is assessed by improvements in the symptoms, since objective evaluation is difficult. We propose conjunctival impression cytology as an objective method to evaluate the effectiveness of surgery for floppy eyelid syndrome.

Method: Prospective interventional study in 16 patients (26 eyelids) with FES, enrolled over a period of 8 months. Patients were examined 1 to 4 weeks before surgery and 16 weeks after surgery. Presence of ocular symptoms was documented. Slit lamp examination was performed. The severity of eyelid laxity was measured in the four lids by the distraction and snapback tests. Cases were classified into three groups according to the severity of symptoms and papillary reaction. Impression cytology using a Millipore filter was performed in all patients at 1 to 4 weeks before surgery and 16 weeks after surgery. A full-thickness pentagonal wedge resection was performed in the upper eyelid.

Results: All patients reported a subjective improvement in symptoms. Postoperative improvements in cellular morphology and goblet cell count were found in 20 of 22 eyelids (91%), which led to a decrease of least one grade in Nelson’s Classification. In two cases (9%) Nelson grade remained stable. Postoperative improvement on cytology was statistically significant with Wilcoxon signed ranks test (p<0.001).

Conclusion: Conjunctival cytology provides an objective method to evaluate the efficacy of surgical techniques proposed for the treatment of eyelid laxity syndromes.