Epidemiology of eyelid disorders in an elderly population: Tehran Geriatric Eye Study

PURPOSE: To determine the prevalence and risk factors of some eyelid disorders in adults aged 60 years and older. METHODS: This population-based, cross-sectional study was conducted in Tehran, Iran, in 2019. Participants were selected via a multistage, stratified random-cluster sampling method. After selection and transportation to the examination site, all participants underwent a standard optometric examination, including visual acuity testing, manifest and subjective refraction. A subsequent comprehensive ophthalmic examination, including slit-lamp biomicroscopy, was performed by an ophthalmologist who diagnosed all eyelid disorders. RESULTS: Of the 3761 individuals selected, 3310 participated in the study. Complete eyelid examinations were performed for 3267 participants (1895 [58%] female; mean age 68.2 ± 49.6 years, range 60-97). Prevalence varied widely by disorder, from 0.23% (entropion) to 55.15% (dermatochalasis). The full prevalence rates were as follows: floppy eyelid syndrome, 0.25%; ectropion, 0.68%; entropion, 0.23%; ptosis, 0.48%; brow ptosis, 5.01%; dermatochalasis, 55.15%; madarosis, 7.8%; trichiasis, 2.45%; poliosis, 3.07%; and eyelid tumors, 2.25%. The prevalence of most disorders increased with age. The most pronounced age-related increase was observed for poliosis, which rose from 1.78% in the 60-64 year age group to 8.45% in those aged 80 years and older. Multiple logistic regression analysis identified the following significant associations: Floppy eyelid syndrome was significantly more common in men. Ectropion was directly associated with age and inversely associated with diabetes. Ptosis was significantly more common in individuals with diabetes. Dermatochalasis was more common in men and was directly associated with both age and body mass index. Madarosis was directly associated with age and inversely associated with female sex. Trichiasis was directly associated with age and inversely associated with diabetes. Poliosis was more common in women and increased with age. CONCLUSION: This study demonstrates that the prevalence of eyelid disorders increases with age in older adults. We observed significant sex-based differences in several conditions, most notably in eyelid tumors and malpositions, suggesting that aging interacts distinctively with environmental and genetic risk factors between men and women. Furthermore, systemic factors such as diabetes and obesity were also associated with specific eyelid pathologies, underscoring the importance of considering these comorbidities during geriatric examinations.