title: Ocular surface morbidity in eyes with senile sunken upper eyelids.
abstract: OBJECTIVE
  To report ocular surface findings in eyes manifesting senile sunken upper eyelids.
  
  
  METHODS
  Cross-sectional comparative case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any of the materials discussed in this article.
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Lingyi
authors.initials: L
authors.lastname: Liang
authors.forename: Hosam
authors.initials: H
authors.lastname: Sheha
authors.forename: Yao
authors.initials: Y
authors.lastname: Fu
authors.forename: Jingbo
authors.initials: J
authors.lastname: Liu
authors.forename: Scheffer C G
authors.initials: SC
authors.lastname: Tseng
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001767:Blinking; D003229:Conjunctival Diseases / Q000209:etiology* / Q000628:therapy; D003316:Corneal Diseases / Q000209:etiology* / Q000628:therapy; D003430:Cross-Sectional Studies; D005141:Eyelid Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009916:Orbital Diseases / Q000150:complications*; D012189:Retrospective Studies