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Zubair Ansari, Roshni Singh, Stuti Dang, Chrisfouad Alabiad, Anat Galor; Prevalence, risk factors, and morbidities of eye lid laxity in a Veteran population. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1493.
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To study the frequency, risk factors, and morbidity of eyelid laxity in a Veteran population
150 consecutive subjects were evaluated from either an outpatient eye 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. The presence of lower eyelid laxity was determined by the snap back test. A grade of 0 indicated laxity within normal limits, a grade of 1 indicated a delay of one to four seconds for the lower lid to return to its native state. A grade of 2 indicated persistent separation necessitating a blink to return to the normal state. Upper eyelid laxity was determined by the lid distraction test. A grade of 0 indicated laxity within normal limits. A grade of 1 indicated 3 to 6 mm of distraction, and a grade of 2 indicated complete tarsal eversion of the upper eyelid.
Fifty-four percent of participants (n=81) had laxity (grade 1 or higher) in either the upper and/or lower eyelids. Risk factors for eyelid laxity in our population included older age, higher body mass index (BMI), 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 to those without laxity (95% confidence interval (CI) 1.15-4.31, p=0.017). and was primarily driven by the presence of upper eyelid laxity.
We found a high frequency 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 the ophthalmic exam in patients with ocular surface discomfort.
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