The relationship between involutional ectropion and inflammatory disorders of the eyelids and ocular surface: insights from a large-scale national study

This study investigated potential associations between ectropion and various chronic and systemic inflammatory diseases affecting the eyelids and ocular surface. This retrospective case-control study, spanning 2001-2022, used electronic medical records from Clalit Health Services (CHS) in Israel. Patients diagnosed with involutional ectropion served as the case group, while two control groups were used for comparison: one comprising patients diagnosed with senile cataract and the other with various ophthalmic diseases. Matching for the control groups was performed at a 1:3 ratio based on year of birth, sex, and ethnicity. A total of 17,292 patients with involutional ectropion and 51,876 matched controls in each group were included. The average age of the patients with involutional ectropion was 78 ± 10 years and 58% were men. Significant associations were found between involutional ectropion and several local inflammatory eyelid diseases: blepharitis (OR 4.66), chalazion (OR 2.94), hordeolum (OR 2.26), and dermatitis of the eyelid (OR 2.46). Ocular surface diseases associated with ectropion included chronic conjunctivitis (OR2.89 ) and pterygium (OR 2.48). Systemic diseases such as hypertension (OR 1.46), dyslipidemia (OR 1.45), and autoimmune rheumatic diseases (OR 1.43) were also associated with involutional ectropion. This study found that localized chronic inflammatory conditions affecting the periocular tissues and ocular surface are significantly associated with the development of involutional ectropion.