Sleep Apnea Linked to Twofold Higher Risk of Eyelid Ptosis and Dermatochalasis

OSA is independently associated with significantly increased risk of eyelid ptosis and dermatochalasis. The nearly twofold increased risk (RR: 1.95) and 39% increased hazard (HR: 1.39) in the composite analysis, along with NNH of 85 patients, represent clinically meaningful effect sizes that persist throughout extended follow-up periods. Photo: Elizabeth Marunde, OD. Click image to enlarge. Ocular complications from obstructive sleep apnea (OSA) have caused worry in patients in recent years, with established associations including floppy eyelid syndrome, increased intraocular pressure, nonarteritic anterior ischemic optic neuropathy and various anterior segment abnormalities. Researchers based out of the University of Pennsylvania recently conducted a large-scale, cohort study to assess the risk of eyelid ptosis and dermatochalasis in patients with OSA, focusing specifically on obese individuals. Individual outcome analyses revealed that both ptosis and dermatochalasis demonstrated robust individual associations with OSA, with ptosis showing a somewhat stronger effect.The retrospective study was conducted using the TriNetX Research Network database (2015 to 2024). Obese patients with OSA (n = 315,223) were matched 1:1 with obese controls without OSA (n = 315,223) based on demographics and comorbidities. The mean age was 65.6 years in both groups, with 55.7% men in the OSA group and 55.4% in controls. Racial distribution showed 73.1% white patients in both cohorts, and 70.3% were non-Hispanic. Follow-up duration was significantly longer in the OSA cohort, with a mean follow-up of 2,088 days (5.7 years) compared to 1,429 days (3.9 years) in controls. For a good overview of the ptosis workup, see this feature. Comorbidity prevalence was similar between groups: diabetes mellitus (28.7% vs. 28.8%), essential hypertension (48.6% vs. 48.5%) and chronic ischemic heart disease (18.1% vs. 17.8%). Primary outcomes included eyelid ptosis and dermatochalasis occurring after OSA diagnosis, analyzed both as a composite outcome and as separate individual outcomes. Statistical analysis included risk ratios (RR), odds ratios (OR), number needed to harm (NNH) and time-to-event analysis with 95% confidence intervals.Eyelid complications occurred in 2.41% of patients with OSA vs. 1.23% of controls. Patients with OSA demonstrated significantly increased risk (RR: 1.95; OR: 1.98; NNH 119 patients). When analyzed separately, ptosis occurred in 1.51% of patients with OSA vs. 0.67% of controls (RR: 2.25). Dermatochalasis occurred in 1.33% of patients with OSA vs. 0.70% of controls (RR: 1.90).“While routine eye care is already recommended for OSA patients due to associations with glaucoma, floppy eyelid syndrome and other ocular conditions, our results suggest that eyelid examination should specifically include assessment for ptosis and dermatochalasis beyond the traditional focus on floppy eyelid syndrome,” the study authors wrote in their paper, which was published in Eye. “Early detection of these conditions could prompt timely intervention and may serve as additional markers for OSA severity or treatment adequacy.”Still, the research team noted that the temporal relationship between OSA and eyelid complications, while appropriate for the study design, does not definitively establish causation. Reverse causation is unlikely given the biological plausibility of OSA preceding eyelid changes, but residual confounding cannot be entirely excluded.They concluded that future research should focus on mechanistic understanding, severity relationships and potential therapeutic interventions to reduce eyelid complication risk in this vulnerable population.Click here for the journal source. Zhao AT, Shen CZ, Katowitz WR. Eyelid ptosis and dermatochalasis in obese patients with obstructive sleep apnea: a large-scale propensity score-matched analysis. Eye (Lond). December 19, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.