IMPACT OF OCULOPLASTIC SURGERY ON GOBLET CELL DENSITY AND THE SUB-BASAL NERVE PLEXUS: IN VIVO CONFOCAL MICROSCOPY AND BLINKING KINEMATICS

Abstract

Introduction: Oculoplastic surgery has been widely used for the functional and aesthetic correction of periocular structures; however, anatomical and biomechanical changes resulting from these procedures can impact the ocular surface. The density of goblet cells—responsible for producing mucins essential for tear film stability—may undergo modifications following eyelid interventions. Objective: To analyze available scientific evidence regarding the impact of oculoplastic surgery on goblet cell density, the sub-basal nerve plexus, and blinking kinematics, relating these changes to ocular surface integrity. Methodology: A systematic literature review was conducted following PRISMA checklist recommendations, considering scientific articles published over the last 10 years in the PubMed, SciELO, and Web of Science databases. Five descriptors were used: “blepharoplasty,” “goblet cells,” “sub-basal nerve plexus,” “in vivo confocal microscopy,” and “blink dynamics.” Inclusion criteria comprised original studies on humans, publications within the established timeframe, and research evaluating ocular surface changes following oculoplastic surgery. Exclusion criteria covered experimental animal studies, works lacking assessment of the outcomes of interest, and duplicate publications or those without full-text availability. Results: The analyzed studies indicated that eyelid procedures could temporarily alter tear film stability and ocular surface function, resulting in reduced goblet cell density and epithelial morphological changes during specific postoperative periods. Conclusion: It was concluded that oculoplastic surgery produces measurable changes in the ocular surface, involving goblet cells, corneal innervation, and eyelid dynamics. In vivo confocal microscopy proved relevant for identifying cellular and neural alterations, while blink analysis complemented the functional assessment. These findings reinforced that monitoring the ocular surface should be part of the postoperative assessment, particularly in patients predisposed to tear film dysfunction.