title: Prevalence, risk factors, and morbidity of eye lid laxity in a veteran population.
abstract: OBJECTIVE
  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.
authors.affiliation: *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.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Ansari
authors.forename: Roshni
authors.initials: R
authors.lastname: Singh
authors.forename: Chrisfouad
authors.initials: C
authors.lastname: Alabiad
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005141:Eyelid Diseases / Q000453:epidemiology*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009123:Muscle Hypotonia / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*