Purpose

Conservative treatment approaches, in addition to surgery, have gained interest in the management of
dermatochalasis, which develops as a result of collagen and elastin degeneration associated with skin
aging. This study aimed to evaluate tissue levels of oxidant and antioxidant molecules following
riboflavin and ultraviolet A (UVA)-induced collagen crosslinking (CXL) in eyelid skin.

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Methods

This prospective study included right upper eyelid skin specimens obtained from 15 patients who
underwent upper blepharoplasty for dermatochalasis. Each specimen was divided into three equal
parts, and superficial micropunctures were applied to the anterior surface before riboflavin instillation.
One part received UVA irradiation at 9 mW for 10 minutes (Group A), another at 30 mW for 3 minutes
(Group B), while the remaining part served as Group C. Biochemical analyses of
superoxide dismutase (SOD), total sulfhydryl (TSH), and advanced oxidative protein products (AOPP)
levels were subsequently performed.

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Results

TSH levels were significantly lower in both Group A (76.12 ± 26.59) and Group B (80.85 ± 28.20) compared to Group C (111.32 ± 46.07) (p = 0.006 and p = 0.046, respectively), with no significant difference between the two CXL groups (p = 0.476). AOPP levels were similar between Group A (55.14 ± 18.09) and Group B (57.49 ± 28.03) (p = 0.975), but significantly higher than Group C (43.52 ± 16.23) (p = 0.047 and p = 0.045, respectively). No statistically significant difference was observed among the groups regarding SOD levels (p = 0.889).

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Conclusion

Riboflavin/UVA-induced CXL applied to eyelid skin was associated with increased oxidative stress and decreased antioxidant molecule levels at the tissue level. Although oxidative reactions constitute the basis of the CXL mechanism, UV-related oxidative damage is also implicated in periocular aging and eyelid tumorigenesis. Therefore, before eyelid CXL can be considered for routine clinical use in dermatochalasis, careful molecular and analytical studies are needed to establish standardized protocols and eliminate potential tissue-related risks.

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Additional Authors

First name	Last name	Base Hospital / Institution
Ummuhani	Ozel Turkcu	Mugla Sitki Kocman University, Faculty of Medicine, Department of Medical Biochemistry, Mugla, Turkiye
Nilay	Yuksel	University of Health Sciences, Ankara Bilkent City Hospital, Department of Ophthalmology, Ankara, Turkiye
Ozlem	Evren Kemer	University of Health Sciences, Ankara Bilkent City Hospital, Department of Ophthalmology, Ankara, Turkiye

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