Purpose

To assess the impact of upper-eyelid position on corneal epithelial thickness distribution and optical quality.

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Methods

In this prospective cross-sectional study, eyes with ptosis and dermatochalasis were compared with matched controls. Anterior segment OCT (MS-39, CSO) was used for epithelial thickness mapping and corneal aberrometry (3- and 6-mm zones). Margin reflex distance (MRD) was correlated with epithelial and higher-order aberration (HOA) parameters.

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Results

Ninety-one eyes were included (36 ptosis, 13 dermatochalasis, 42 controls). Ptosis showed significant superior epithelial thinning with corresponding inferior thickening, resulting in a pronounced superior–inferior gradient compared with controls (6 mm: −10.9 vs −3.8 μm; 4 mm: −6.8 vs −2.5 μm), whereas dermatochalasis showed no differences.
HOAs were increased in ptosis, including total HOA RMS (3 mm: 0.176 vs 0.097 μm; 6 mm: 1.01 vs 0.54 μm), spherical aberration (Z(4,0): −0.58 vs −0.29 μm), and coma RMS (3 mm: 0.073 vs 0.041 μm; 6 mm: 0.439 vs 0.291 μm).
MRD correlated strongly with epithelial thickness gradients and HOAs.

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Conclusion

Eyelid position influences corneal epithelial remodeling and HOAs, with lower MRD associated with a more pronounced epithelial thickness gradient and increased HOAs. Eyelid position represents an under-recognized source of optical degradation that should be considered in clinical evaluation and surgical planning.

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Additional Authors

First name	Last name	Base Hospital / Institution
Michelle	Neumaier	Augenklinik LMU München
Niklas	Mohr	Augenklinik LMU München

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