Prevalence and risk factors of childhood blepharoptosis in Koreans: the Korea National Health and Nutrition Examination Survey

Blepharoptosis and cognitive performance: a population-based study of 1.4 million adolescents

The purpose of this study is to examine the association between blepharoptosis and cognitive performance in late adolescence. This population-based, retrospective, cross-sectional study included 1,411,570 Israeli-born adolescents (620,107 women, 43.9%) aged 16-19 years who were medically examined before compulsory military service between 1993 and 2017. The diagnosis of blepharoptosis was verified by an ophthalmologist. Cognitive performance was assessed by a validated intelligence-quotient-equivalent test, comprising four domains (problem-solving, verbal abstraction and categorization, verbal comprehension, and mathematical abilities). Cognitive Z-scores were calculated and categorized as high (≥ 1 standard deviation (SD)), medium (- 1 to < 1 SD), and low (less than - 1 SD). Relationships were analyzed using regression models adjusted for sociodemographic variables including sex, year of birth, residential socioeconomic status, education level, body mass index, and familial country of origin. A total of 577 (41 per 100,000, 32.2% women) adolescents were diagnosed with blepharoptosis. The proportions of unilateral and bilateral visual impairment among adolescents with blepharoptosis were 13.0% and 3.5%, respectively. In a multivariable analysis, blepharoptosis was associated with a 0.18 SD reduction in cognitive Z-score (p < 0.001). The adjusted odds ratios for low and high cognitive Z-scores in adolescents with blepharoptosis were 1.54 (1.25-1.89) and 0.80 (0.62-1.04), respectively. This relationship persisted when adolescents with normal best-corrected visual acuity or unimpaired health status were analyzed separately.  Conclusions: Blepharoptosis is associated with reduced cognitive performance determined in late adolescence. Future prospective studies should investigate the causes of this link and their underlying mechanisms. What is Known: • While earlier investigations have examined the effects of blepharoptosis on vision and quality of life, the association between blepharoptosis and cognitive outcomes in youth has remained unexplored. What is New: • This nationwide study involving 1.4 million Israeli adolescents found a correlation between blepharoptosis and reduced cognitive performance. • Our findings suggest a potential interplay between blepharoptosis and cognitive development in the pediatric population, calling for increased focus on the educational needs of affected individuals.

Modified conjoint fascial sheath suspension for the correction of severe congenital blepharoptosis in pediatric patients at different ages

OBJECTIVE

To evaluate the surgical outcomes of modified combined fascia sheath (CFS) and levator muscle (LM) complex suspension for the correction of severe congenital blepharoptosis in pediatric patients.

METHODS

Pediatric patients with severe congenital blepharoptosis were enrolled form July 2017 to July 2021. All patients were divided into two groups according to their age (group A ≤ 7 years; group B > 7 years) and received CFS + LM suspension surgery. Main surgical outcome indexes include margin reflex distance 1 (MRD1) and MRD1 regression. Postoperative complications such as lagophthalmos (LAG), conjunctival prolapse, exposure keratopathy and trichiasis were documented.

RESULTS

Fifty patients (60 eyes) were enrolled, including 17 patients (18 eyes) in group A and 33 patients (42 eyes) in group B. The MRD1 in group A was 3.06 ± 0.64 mm at 6 months after the operation, and the MRD1 in group B was 2.64 ± 0.69 mm 6 months postoperatively which is significantly lower than that of group A (P = 0. 044). At the last visit, however, the MRD1 in group A was 3.00 ± 0.69 mm and the MRD1 in group B was 2.64 ± 0.70 mm. There was no significant difference in MRD1 between two groups in long term (P = 0.255). Additionally, there were a variety of degrees of MRD1 regression, especially in the first month after the operation in both groups (both P < 0.001). Moreover, there were 9 cases of postoperative complications in group A and 13 cases in group B. The overall occurrence of postoperative complications in group A was significantly lower than that in groups B (χ ²  = 4.413, P = 0.036).

CONCLUSIONS

CFS + LM suspension, a modified CFS-based surgery, is an effective treatment for severe congenital blepharoptosis in pediatric patients. Moreover, CFS + LM suspension demonstrate excellent long-term outcomes, including good movement of the eyelid, satisfied eyelid closure and fewer postoperative complications.

Correlation between body composition and blepharoptosis in adults

BACKGROUND

The present study aimed to explore the association between body composition indices, such as fat mass (FM) and lean body mass (LBM), and blepharoptosis.

METHODS

The study evaluated 12,168 Korean adults aged 40 years or older using data from the Korea National Health and Nutrition Examination Survey (2008-2011). FM index (FMI, kg/m²) and LBM index (LBMI, kg/m²) were used to correct for the effects of body size. Multivariable logistic regression analysis was performed to investigate the association between blepharoptosis and body composition indices such as FMI, LBMI, and fat percentage of whole body or head. Stratified analyses were also performed by levator function.

RESULTS

Higher FMI and head fat percentage were significantly associated with blepharoptosis (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; and aOR = 1.32, 95% CI = 1.03-1.69 in the highest tertile compared with the lowest, respectively). In the subgroup with good levator function (≥8 mm), higher FMI, head fat percentage, and head lean mass were significantly associated with blepharoptosis (aOR for the right eye [aORr] = 1.42 and aOR for the left eye [aORl] = 1.36; aORr = 1.41 and aORl = 1.37; and aORr = 1.50 and aORl = 1.49 in the highest tertile compared with the lowest, respectively; all p < 0.05).

CONCLUSIONS

Body compositions with high adiposity indices, such as high FMI and head fat percentage, were positively associated with blepharoptosis. Awareness of the potential correlation between obesity-associated fat deposition and blepharoptosis could improve management of the condition and contribute to understanding the pathogenesis of blepharoptosis.