Upper-Eyelid Position–Dependent Corneal Epithelial Remodeling And Its Impact On Higher-Order Aberrations

To evaluate the effect of upper-eyelid pathology on corneal epithelial thickness distribution and to assess the relationship between epithelial remodeling, higher-order aberrations (HOAs), and eyelid position.

Department of Ophthalmology, LMU University Hospital, Munich, Germany.

In this prospective cross-sectional study, one eye per subject was included. Eyes with ptosis and dermatochalasis were compared with age- and sex-matched healthy controls. All eyes underwent corneal imaging using anterior segment OCT (MS-39, CSO) with epithelial thickness mapping and corneal aberrometry in the 3-mm and 6-mm zones. Intergroup differences were analysed using ANOVA with Bonferroni post-hoc testing. Margin reflex distance (MRD) was correlated with epithelial and HOA parameters using Spearman’s rho.

Ninety-one eyes were analysed (36 ptosis, 13 dermatochalasis, 42 controls). The ptosis group 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 did not differ from healthy eyes. HOAs were higher in ptosis than in controls, 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 the superior–inferior epithelial thickness gradient and with HOAs.

Corneal epithelial remodeling and corneal HOAs are dependent on eyelid position, with lower MRD being associated with a more pronounced epithelial thickness gradient and higher HOAs. Eyelid position represents a previously under-recognised source of optical degradation and may lead to misinterpretation of corneal diagnostics.