title: Impact of Eyelid Laxity on Symptoms and Signs of Dry Eye Disease.
abstract: OBJECTIVE
  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.
authors.affiliation: *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.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Chhadva
authors.forename: Allison L
authors.initials: AL
authors.lastname: McClellan
authors.forename: Chrisfouad R
authors.initials: CR
authors.lastname: Alabiad
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.forename: Hatim
authors.initials: H
authors.lastname: Batawi
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
mesh_terms: D000368:Aged; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D011795:Surveys and Questionnaires