Decreased carotenoid content in preaponeurotic orbital fat of patients with involutional ptosis

The underlying cause of involutional blepharoptosis is unknown. The carotenoid content of preaponeurotic and nasal orbital fat among patients with and without involutional ptosis was evaluated to investigate the hypothesis that development of ptosis may be related to low carotenoid content of preaponeurotic orbital fat.

Through a case-control design, the carotenoid content of preaponeurotic and nasal fat of 10 patients with ptosis and 11 patients without ptosis was measured by spectrophotometry analysis. Differences in carotenoid content between patients with and without ptosis were evaluated in unadjusted analyses and in multivariate models adjusted for age, sex, race, and presence of thyroid eye disease as potential confounders.

The total carotenoid content of the preaponeurotic fat of patients with ptosis was 59% lower than patients without ptosis (2.98 versus 7.26 absorbance/mg, p = 0.005). When adjustments were made for age, sex, race, and presence of thyroid eye disease, this difference was attenuated, but there was still a trend toward lower preaponeurotic fat carotenoid content among patients with ptosis (p = 0.09). The carotenoid content of the nasal fat was not significantly different among patients with and without ptosis (2.69 versus 3.40 absorbance/mg, p = 0.33). A lower ratio of preaponeurotic to nasal carotenoid content was demonstrated among patients with ptosis compared with patients without ptosis (1.4 versus 2.1; p = 0.06 unadjusted, p = 0.10 adjusted).

Patients with involutional ptosis show trends toward having lower carotenoid content in preaponeurotic fat. Further investigation of the potential role of orbital fat carotenoids in the development of involutional ptosis is warranted.