Prevalence of Eyelid Laxity and its Association with Ophthalmic Findings and Disease Severity in Patients with Keratoconus

Purpose To investigate the prevalence of eyelid laxity and quantify eyelid measurements in normal and keratoconic eyes and the correlations of these findings with ophthalmic parameters and disease severity in patients with keratoconus (KC). Methods In a prospective case-control study, prevalence of eyelid laxity and eyelid measurements were evaluated in 53 patients with KC and the same number of matched healthy controls. The eyelid measurements were compared between the groups, as well as mean keratometry (K), central and thinnest corneal thickness (CCT and TCT), astigmatism, manifest refraction spherical equivalent (MRSE), best spectacle-corrected visual acuity (BCVA), and severity of KC according to the Keratoconus Severity Score. Results Prevalence of eyelid laxity was 71.7% (38 patients) in patients with KC and 20.8% (11 patients) in normal participants (p<0.001, odds ratio 9.673 [95% confidence interval 3.959 to 23.631]). Comparison of the eyelid measurements in the patients with KC with and without eyelid laxity revealed significantly higher measurements of anterior eyelid distraction test, Hertel exophthalmometry measurements, lateral canthal angle to orbital rim and tendon movement, palpebral fissure width, retraction test (lower eyelid), and vertical lid pull (upper eyelid) in patients with KC with eyelid laxity (p<0.05). No significant difference was found regarding mean K, CCT, TCT, astigmatism, MRSE, or BCVA values of the patients with KC with and without eyelid laxity (p>0.05). Moreover, severity of KC was not associated with the presence of eyelid laxity or eyelid measurements (p>0.05). Conclusions Higher prevalence and greater eyelid laxity were found in patients with KC compared to healthy participants. However, eyelid laxity was not associated with severity of KC.