Blepharoptosis as a Modifiable Risk Factor for Falls and Fractures in Adults: A Large-Scale Retrospective Study

To evaluate whether blepharoptosis is associated with an increased risk of incident falls and fractures among adults.

This retrospective cohort study utilized data from the TriNetX Health Research Network (January 2004 to January 2024). Adults aged 18 years or older diagnosed with blepharoptosis were matched 1:1 with controls who underwent an ophthalmologic examination without any abnormal findings. Exclusion criteria included severe ocular pathology, low vision/blindness, or falls/fractures within 6 months before the diagnosis. The primary outcomes were incident falls and fractures within 1 year, assessed using risk ratios (RRs) and Cox regression.

A total of 119,101 matched patient pairs were analyzed. At 2 weeks postdiagnosis, patients with blepharoptosis had a significantly increased risk of falls (RR, 1.53; confidence interval [CI]: 1.18-1.98; p < 0.01) and fractures (RR, 2.46; CI: 2.02-3.00; p < 0.01). Fracture risk remained elevated at 3 months and was most pronounced in the skull, facial, and cervical regions (RR, 2.87; 95% CI: 2.32-3.55; p < 0.01). By 1 year, patients who underwent blepharoptosis repair (15.4%) had a significantly lower fall risk compared to those who did not (RR, 0.65; 95% CI: 0.54-0.77; p < 0.01), with multivariable analysis showing an 89% risk reduction (hazard ratio, 0.11; 95% CI: 0.02-0.83; p = 0.03).

Blepharoptosis is associated with an increased risk of falls and fractures, particularly among older adults. Surgical correction mitigates this risk, suggesting a potential role for blepharoptosis repair in fall prevention strategies.