Using multidetector row computed tomography to evaluate baggy eyelid

Abstract

Background: Baggy eyelids, formed by intraorbital fat herniation in the lower eyelids, are a sign of aging observed in the midface. This study aimed to identify the cause of baggy eyelids by evaluating the relationship between orbicularis oculi muscle thickness, orbital fat prolapse length, and age using multidetector row computed tomography (MDCT).

Methods: The 34 patients in the study ranged in age from 20 to 79 years. The patients were divided into three age groups: 20-29 years, 30-54 years, and 55-79 years. Orbicularis oculi muscle thickness and orbital fat prolapse length were measured using reconstructed computed tomography (CT) images.

Results: The orbicularis oculi muscle was found to be significantly thinner in the oldest group. Likewise, orbital fat prolapse was found to be significantly more prominent in the oldest group. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = -0.78; P < 0.001) and between orbicularis oculi muscle thickness and age (r = -0.77; P < 0.001). A strong and significant positive correlation was found between orbital fat prolapse length and age (r = 0.78; P < 0.001).

Conclusions: The use of MDCT provides insight into the detailed changes associated with aging that take place within the lower eyelids. This study objectively demonstrated that the major factors associated with baggy eyelids include orbicularis oculi muscle thickness, orbital fat prolapse length, and age. Decreased orbicularis oculi muscle thickness leads to the orbital fat prolapse.

Fig. 1

Baggy eyelid measurements. Sagittal reconstructed images created vertical to the orbit (white box) were used for measurements of orbicularis oculi thickness and orbital fat prolapse. A line (dotted) running from the anterior edge of the orbital roof to the anterior edge of the orbital floor was used as a reference for measuring orbital fat prolapse length. White line: Orbital fat prolapse length, indicating the measurement made from the posterior margin of the orbicularis oculi muscle to the reference line. Black line: Orbicularis oculi muscle thickness measurement

Fig. 2

Correlation between orbicularis oculi muscle thickness and orbital fat prolapse length. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = –0.78; P < 0.001). Specifically, as the orbicularis oculi muscle becomes thinner, the orbital fat prolapse becomes more prominent

Fig. 3

Correlation between orbicularis oculi muscle thickness and age. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and age (r = −0.77; P < 0.001). Specifically, with age, the orbicularis oculi muscle becomes thinner

Fig. 4

Correlation between length of orbital fat prolapse and age. A strong and significant positive correlation was found between orbital fat prolapse length and age (r = 0.78; P < 0.001). Specifically, with age, orbital fat prolapse length increases

Fig. 5

A 22-year-old man who showed no orbital fat prolapse. The thickness of the orbicularis oculi muscle shown with the black line is 2.5 mm

Fig. 6

A 63-year-old man who showed orbital fat prolapse. The orbital prolapse length (5.9 mm) is shown by the white line. The orbicularis oculi muscle thickness (1.8 mm) is shown by the black line