Skip to main content
SpringerLink
Log in

Conjunctival changes following Muller’s muscle conjunctival resection

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To analyze the conjunctival changes, especially goblet cell populations, following Muller’s muscle conjunctival resection (MMCR) by histologically evaluating pre and post-MMCR specimens.

Methods

This is a retrospective analysis of conjunctival samples sent for histologic evaluation from two patient populations: those who had previously undergone a MMCR and required repeat surgery and controls who underwent a MMCR surgery in a previously unoperated eyelid. Specimens underwent hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining to accentuate goblet cell identification and were evaluated by two ocular pathologists to quantify goblet cell populations and note other anatomical changes. Statistical analysis of goblet cell populations was then performed.

Results

Four samples were identified for each group: (1) post-MMCR and (2) control. The mean age was 67 years in the post-MMCR group and 66 years in the control group. The mean goblet cell population was 7 ± 5 cells/mm in the post-MMCR conjunctiva and was 39 ± 16 cells/mm in the control group, which was statistically significant (p = 0.01). Samples from both groups demonstrated scarring and inflammatory cell infiltrate.

Conclusions

While there was a relative loss of goblet cell populations in the conjunctiva overlying the region of surgery following MMCR, the lack of dry eye symptoms or changes in tear production reported in prior studies suggests that there may be enough goblet cell population reserve in the remaining accessory lacrimal glands and in the unaltered conjunctiva to provide sufficient lubrication and ocular protection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data set is available and uploaded as a supplemental document.

Code availability

N/A.

References

  1. Putterman AM, Urist MJ (1975) Müller’s muscle-conjunctival resection: technique for treatment of blepharoptosis. Arch Ophthalmol 93:619–623

    Article  CAS  Google Scholar 

  2. Ali M, Shah D, Pasha Z, Jassim SH, Jaboori AJ, Setabutr P et al (2017) Evaluation of accessory Lacrimal Gland in Muller’s Muscle Conjunctival resection specimens for precursor cell markers and biological markers of dry eye disease. Curr Eye Res 42(4):491–497

    Article  CAS  Google Scholar 

  3. Shields M, Putterman A (2003) Re: “Müller muscle-conjunctival resection: effect on tear production.” Ophthalmic Plast Reconstr Surg 19(3):254–255

    Article  Google Scholar 

  4. Marcet MM, Setabutr P, Lemke BN, Collins ME, Fleming JC, Wesley RE et al (2010) Surgical microanatomy of the Müller Muscle-Conjunctival resection ptosis procedure. Ophthalmic Plast Reconstr Surg 26(5):360–364

    Article  Google Scholar 

  5. Kulchaiyawat V, Aakalu VK, Sajja K, Gupta S, Hallak J, Setabutr P (2010) A clinicopathological correlation between Müller’s Muscle Conjunctival resection and corneal staining pattern. Invest Ophthalmol Vis Sci 51(13):1472

    Google Scholar 

  6. Gipson IK (2016) Goblet cells of the conjunctiva: A review of recent findings. Prog Retin Eye Res 54:49–63

    Article  Google Scholar 

  7. Marko CK, Menon BB, Chen G, Whitsett JA, Clevers H, Gipson IK (2013) Spdef null mice lack conjunctival goblet cells and provide a model of dry eye. Am J Pathol 183(1):35–48

    Article  CAS  Google Scholar 

  8. Dailey RA, Saulny SM, Sullivan SA (2002) Müller muscle-conjunctival resection effect on tear production. OPRS 6:421–425

    Google Scholar 

  9. Rymer BL, Marinho DR, Cagliari C, Marafon SB, Procianoy F (2017) Effects of Müller’s muscle-conjunctival resection for ptosis on ocular surface scores and dry eye symptoms. Orbit 36(1):1–5

    Article  Google Scholar 

  10. Uğurbaş SH, Alpay A, Bahadır B, Uğurbaş SC (2014) Tear function and ocular surface after Muller muscle-conjunctival resection. Indian J Ophthalmol 62(5):654–655

    Article  Google Scholar 

  11. Vrcek I, Hogan RN, Rossen J, Mancini R (2016) Conjunctiva-Sparing Posterior Ptosis Surgery: A Novel Approach. Ophthalmic Plast Reconstr Surg 32(5):366–370

    Article  Google Scholar 

  12. Dortzbach RK (1979) Superior tarsal muscle resection to correct blepharoptosis. Ophthalmology 86(10):1883–1891

    Article  CAS  Google Scholar 

  13. Bealka PJ, Somogyi M, Nakra T (2017) Re: “Conjunctiva-Sparing Posterior Ptosis Surgery: A Novel Approach.” Ophthalmic Plast Reconstr Surg 33(5):392

    Article  Google Scholar 

  14. Abdel-khalek LM, Williamson J, Lee WR (1978) Morphological changes in the human conjunctival epithelium. I. In the normal elderly population. Br J Ophthalmol 62(11):792–799

    Article  CAS  Google Scholar 

  15. Kessing SV (1968) Mucous gland system of the conjunctiva. A quantitative normal anatomical study. Acta Ophthalmol (Copenh). ;Suppl 95:1+.

  16. Moore CP, Wilsman NJ, Nordheim EV, Majors LJ, Collier LL (1987) Density and distribution of canine conjunctival goblet cells. Invest Ophthalmol Vis Sci 28(12):1925–1932

    CAS  PubMed  Google Scholar 

  17. Knop N, Korb DR, Blackie CA, Knop E (2012) The lid wiper contains goblet cells and goblet cell crypts for ocular surface lubrication during the blink. Cornea 31(6):668–679

    Article  Google Scholar 

  18. Stewart RM, Sheridan CM, Hiscott PS, Czanner G, Kaye SB (2015) Human Conjunctival Stem Cells are Predominantly Located in the Medial Canthal and Inferior Forniceal Areas. Invest Ophthalmol Vis Sci 56(3):2021–2030

    Article  CAS  Google Scholar 

  19. Pflugfelder SC, Corrales RM, De paiva CS. T helper cytokines in dry eye disease. Exp Eye Res. 2013; 117: 118–25.

  20. Greiner JV, Henriquez AS, Covington HI, Weidman TA, Allansmith MR (1981) Goblet cells of the human conjunctiva. Arch Ophthalmol 99(12):2190–2197

    Article  CAS  Google Scholar 

  21. Henriksson JT, De Paiva CS, Farley W, Pflugfelder SC, Burns AR, Bergmanson JP (2013) Morphologic alterations of the palpebral conjunctival epithelium in a dry eye model. Cornea 32(4):483–490

    Article  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA

    Robert Beaulieu, Emma McDonnell, Stacy M. Scofield-Kaplan, R. Nick Hogan & Ronald Mancini

  2. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Bret M. Evers & R. Nick Hogan

  3. Department of Ophthalmology, Detroit Medical Center, Kresge Eye Institute, Detroit, MI, USA

    Robert Beaulieu

  4. Consultants in Ophthalmic and Facial Plastic Surgery, Southfield, MI, USA

    Robert Beaulieu

  5. Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA

    Emma McDonnell

  6. Department of Ophthalmology, Stony Brook University Medical Center, Stony Brook, NY, USA

    Stacy M. Scofield-Kaplan

Authors
  1. Robert Beaulieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emma McDonnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stacy M. Scofield-Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bret M. Evers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Nick Hogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ronald Mancini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all of the authors. The first draft of the manuscript was written by Robert Beaulieu MD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ronald Mancini.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Financial support

None.

Proprietary interest statement

The authors have nothing to disclose.

Ethics approval

This retrospective chart review study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the University of Texas Southwestern Medical Center Institutional Review Board (IRB).

Consent to participate

N/A (pathology slides were used).

Consent for publication

N/A.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 8 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beaulieu, R., McDonnell, E., Scofield-Kaplan, S.M. et al. Conjunctival changes following Muller’s muscle conjunctival resection. Int Ophthalmol 42, 1689–1695 (2022). https://doi.org/10.1007/s10792-021-02163-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-02163-8

Keywords

Search

Navigation