Chronological Characteristics of the Tarsal Plate: Age‑Related Changes in the Meibomian Gland and Connective Tissue Fibers

PURPOSE: To characterize age-related changes in the tarsal plate, with a focus on meibomian gland loss and alterations in collagen, elastic, and reticular fibers. METHODS: Central sagittal sections of 31 upper eyelids from 20 East Asian cadavers, fixed in 10% formalin, aged 36 to 97 years were examined using Masson's trichrome staining. Additional sections of 25 upper eyelids from 16 cadavers, fixed in 10% formalin, aged 36-94 years were evaluated with Elastica-van Gieson and silver staining. RESULTS: In individuals in their 30s and 40s, acini extended to the superior tarsal region in most specimens, although 2 specimens from one 36-year-old individual showed complete acinar loss. Acinar loss became more apparent in the 50s and was pronounced after the 60s, although some specimens still retained acini in the central to superior tarsus. Acinar loss was consistently greater on the conjunctival side than on the skin side. Elastic fibers were typically present around the meibomian ducts but were nearly absent in acinar-loss areas. Reticular fibers were abundant in acinar-containing regions and remained densely distributed in acinar-loss areas, where collagen fibers filled the original acinar spaces. CONCLUSIONS: Meibomian gland volume generally decreased with age, although individual variation was evident. Preferential acinar loss on the conjunctival side suggests regional susceptibility. The disappearance of elastic fibers, together with dense reticular and collagen fiber deposition, raises the possibility that inflammatory remodeling may contribute to age-related meibomian gland loss.