title: The Prevalence of Ptosis and Its Association with Amblyopia and Strabismus in 7-Year-Old Schoolchildren in Iran.
abstract: OBJECTIVE
  To determine the prevalence of ptosis (congenital/acquired) in Iranian children aged 7 years and its relationship with amblyopia and strabismus.
  
  
  METHODS
  Eight Iranian cities were selected for this cross-sectional study using multistage randomized cluster sampling. A number of primary schools were randomly selected in each city. All grade 1 students in each selected primary school underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, cover test, and cycloplegic and non-cycloplegic refraction.
  
  
  RESULTS
  Of 4614 selected students, 4106 students participated in the study (response rate = 89%). The prevalence of ptosis (congenital/acquired) was 1.41% (95% CI 1-1.83); 0.49% (95% CI 0.26-0.72) and 0.93% (95% CI 0.59-1.26) had unilateral and bilateral ptosis, respectively. The prevalence of ptosis had no significant correlation with sex (p = 0.810, OR = 1.07, 95% CI 0.59-1.97). The prevalence of amblyopia was 48.28% and 0.89% in students with and without ptosis, respectively. The prevalence of tropia was significantly higher in cases with bilateral ptosis (p < 0.001). The mean cylinder error was 1.63 ± 1.72 and 0.44 ± 0.60 in ptotic and non-ptotic eyes, respectively (p < 0.001). With-the-rule (WTR) astigmatism was significantly more prevalent in students with ptosis.
  
  
  CONCLUSIONS
  We report the prevalence of ptosis (congenital/acquired) in children in Iran and the Middle East region for the first time. Amblyopia was considerably more prevalent in ptotic patients. We found a significant correlation between ptosis and tropia. Astigmatism, especially WTR stigmatism, was more prevalent in children with ptosis.
authors.affiliation: a Noor Ophthalmology Research Center, Noor Eye Hospital , Tehran , Iran .
authors.forename: Hassan
authors.initials: H
authors.lastname: Hashemi
authors.affiliation: a Noor Ophthalmology Research Center, Noor Eye Hospital , Tehran , Iran .
authors.forename: Payam
authors.initials: P
authors.lastname: Nabovati
authors.affiliation: a Noor Ophthalmology Research Center, Noor Eye Hospital , Tehran , Iran .
authors.forename: Nooshin
authors.initials: N
authors.lastname: Dadbin
authors.affiliation: a Noor Ophthalmology Research Center, Noor Eye Hospital , Tehran , Iran .
authors.forename: Zahra
authors.initials: Z
authors.lastname: Heidari
authors.affiliation: b Department of Optometry , School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad , Iran .
authors.forename: AbbasAli
authors.initials: A
authors.lastname: Yekta
authors.affiliation: c Department of Optometry , Iran University of Medical Sciences , Tehran , Iran .
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Jafarzadehpur
authors.affiliation: d Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad , Iran , and.
authors.forename: Hadi
authors.initials: H
authors.lastname: Ostadimoghaddam
authors.affiliation: e Department of Epidemiology, Faculty of Public Health , Shahid Beheshti University of Medical Sciences , Tehran , Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Khabazkhoob
mesh_terms: D000293:Adolescent; D000550:Amblyopia / Q000453:epidemiology*; D001251:Astigmatism; D001763:Blepharoptosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D009907:Optometry; D015995:Prevalence; D012574:Schools; D013285:Strabismus / Q000453:epidemiology*; D014792:Visual Acuity
keywords: Children; prevalence; ptosis