# Association of decreased lymphatic vessel density with postoperative eyelid edema

## TL;DR

This study found that lower lymphatic vessel density in eyelid skin is linked to more severe swelling after upper eyelid surgery.

## Contribution

The study identifies lymphatic vessel density as a novel predictor of postoperative eyelid edema severity.

## Key findings

- Severe edema was associated with significantly lower lymphatic vessel density (8.00 ± 1.67 vessels/mm²) compared to mild or no edema (12.14 ± 1.93 vessels/mm²).
- Lymphatic vessel area and perimeter were not significantly associated with postoperative edema grades.

## Abstract

We sought to investigate whether variations in lymphatic morphology are associated with postoperative eyelid edema in patients who underwent upper eyelid blepharoplasty.

This was a prospective study in which nine upper eyelid skin samples were stained with Podoplanin to immunochemically mark lymphatic vessels. Lymphatic vessel area, density, and perimeter were calculated from averaging 38 slices across 3 cuts of eyelid skin. Corresponding postoperative patient photographs were graded by four physicians with a standardized postoperative edema grading scale that ranged from zero (no edema) to three (severe edema). Patients were classified as having clinically significant eyelid edema (CSEE) if they received an edema grade greater than zero 90 days postoperatively or a grade of three at any time point.

Anti-podoplanin staining demonstrated that there was significantly lower lymphatic vessel density among patients with severe edema (8.00 ± 1.67 vessels/mm2) compared to patients with mild or no edema (12.14 ± 1.93 vessels/mm2, p < 0.05). Lymphatic vessel area and perimeter did not reveal any significant associations with postoperative edema grades.

In patients undergoing an upper eyelid blepharoplasty, severe postoperative swelling was significantly associated with lower lymphatic vessel density, but not with lymphatic vessel area or perimeter. These findings suggest that the lymphatic network of the eyelid could play a role in the degree of postoperative swelling.