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Impact of Eyelid Laxity on Symptoms and Signs of Dry Eye Disease

Chhadva, Priyanka BS; McClellan, Allison L. OD; Alabiad, Chrisfouad R. MD; Feuer, William J. MS; Batawi, Hatim MD; Galor, Anat MD, MSPH

doi: 10.1097/ICO.0000000000000786
Clinical Science

Purpose: To study the relationship between eyelid laxity and ocular symptoms and signs of dry eye (DE).

Methods: A total of 138 patients with normal external anatomy were prospectively recruited from a Veterans Administration hospital. Symptoms (via the Dry Eye Questionnaire 5 and Ocular Surface Disease Index) and signs of DE were assessed along with presence or absence of eyelid laxity.

Results: It was observed that 71% of participants (n = 98) had clinical evidence of eyelid laxity (upper and/or lower) compared with 29% (n = 40) with no eyelid laxity. Individuals with eyelid laxity were older (67 ± 10 vs. 55 ± 8 years without laxity, P < 0.005) and more frequently male (76% of males had laxity vs. 18% females, P < 0.005). Patients with eyelid laxity had increased symptoms and signs of DE compared with their counterparts without laxity including ocular pain described as grittiness (63% vs. 45%, P = 0.049), decreased tear break-up time (8.6 ± 3 vs. 10.3 ± 4 seconds, P = 0.02), increased corneal staining (2.5 ± 3 vs. 1 ± 2, P = 0.002), decreased Schirmer score (14±6 vs. 17±7 mm, P = 0.01), increased meibomian gland drop out (2 ± 1 vs. 0.8 ± 0.8, P < 0.005), increased eyelid vascularity (0.8 ± 0.8 vs. 0.2 ± 0.5, P < 0.005), and more abnormal meibum quality (2 ± 1.3 vs. 1.4 ± 1.2, P = 0.02). In a multivariable analysis considering both signs of DE and laxity, lower eyelid laxity remained significantly associated with ocular surface disease index scores, suggesting a direct effect of laxity on symptoms of DE.

Conclusions: The presence of eyelid laxity associates with abnormal tear parameters compared with the absence of eyelid laxity. Based on these data, it is important for clinicians to test for eyelid laxity in patients with symptoms and/or signs of DE.

*University of Miami Miller School of Medicine, Miami, FL;

Bascom Palmer Eye Institute, University of Miami, Miami, FL; and

Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL.

Reprints: Anat Galor, MD, Department of Ophthalmology, Miami VA Medical Center, 1201 NW 16th Street, Miami, FL 33125 (e-mail: agalor@med.miami.edu).

Financial support comes from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development's Career Development Award CDA-2-024-10S (A.G.), NIH Center Core Grant P30EY014801, and Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD-Grant W81XWH-09-1-0675 and Grant W81XWH-13-1-0048 ONOVA) (institutional).

The authors have no conflicts of interest to disclose.

Received October 12, 2015

Received in revised form December 24, 2015

Accepted January 04, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.