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Prevalence, Risk Factors, and Morbidity of Eye Lid Laxity in a Veteran Population

Ansari, Zubair MD; Singh, Roshni; Alabiad, Chrisfouad MD; Galor, Anat MD, MSPH

doi: 10.1097/ICO.0000000000000286
Clinical Science

Purpose: The aim of this study was to study prevalence, risk factors, and morbidity of eyelid laxity in a veteran population.

Methods: This prospective cross-sectional study with a retrospective chart review included 150 subjects evaluated from either an outpatient eye clinic or a geriatric clinic at the Miami Veterans Affairs Hospital from June through August 2013. Clinical data were gathered from a questionnaire and a computerized medical record system including demographics, medical history, and ocular irritation history. Upper and lower eyelid laxity was clinically graded. Main outcome measures were prevalence of eyelid laxity, risk factors for its presence, and its correlation to ocular surface symptoms.

Results: Fifty-four percent of participants (n = 81) had laxity (grade 1 or higher) in either upper and/or lower eyelids. Risk factors for eyelid laxity in our population included older age, higher body mass index, and a diagnosis of sleep apnea. Patients with any eyelid laxity (grade 1 or more in any eyelid) had a 2.23-fold risk of severe ocular surface symptoms (score of 12 or higher on the dry eye questionnaire 5) compared with those without laxity (95% confidence interval, 1.15–4.31; P = 0.017), and this was primarily driven by the presence of upper eyelid laxity.

Conclusions: We found high prevalence of eyelid laxity in our population, and its presence was associated with significant ocular surface morbidity. This study reinforces the need to incorporate dynamic eyelid testing into ophthalmic examination in patients with ocular surface discomfort.

*Miami Veterans Affairs Medical Center;

Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL; and

Marshall University, Joan C. Edwards School of Medicine, Huntington, WV.

Reprints: Anat Galor, MD, MSPH, Department of Surgery, Miami VAMC, 1201 NW 16th St, Miami, FL 33125 (e-mail:

Supported by 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, 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 June 09, 2014

Received in revised form August 29, 2014

Accepted September 05, 2014

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