The Association Between Instillation Of Eye Drops And Lower Eyelid Laxity: A Comparative Study

Involutional ectropion is the most common type of ectropion, primarily affecting older patients due to horizontal eyelid laxity. While its pathogenesis is multifactorial, the impact of topical eye drop use on lower eyelid laxity remains unclear. Patients are commonly instructed to pull down the lower eyelid during drop instillation. This study aimed to evaluate the association between chronic eye drop use and lower eyelid laxity, distinguishing between mechanical and pharmacological influences.

Tertiary referral ophthalmology center

Seventy adult participants were enrolled and divided into three groups: (1) patients with glaucoma using chronic topical anti-glaucoma medications, (2) patients with dry eye using preservative-free artificial tears, and (3) controls with no history of eye drop use. All subjects underwent slit-lamp examination, standardized horizontal eyelid distraction testing, and grading of punctate epithelial erosions (PEE) on a 0–4 scale. Statistical analysis was conducted using ANOVA with post hoc comparisons.

The mean participant age was 65 years, with 33 females (47.1%). The cohort included 20 glaucoma patients (28.6%), 20 dry eye patients (28.6%), and 30 controls (42.8%).
Lower eyelid laxity was significantly greater in the dry eye group (5.00 mm) compared to both the glaucoma group (3.13 mm) and control group (1.98 mm; p < 0.001).
PEEs were observed in both drop-user groups, with mean scores of 1.60 in the glaucoma and dry eye groups, versus 0.07 in controls (p < 0.001).

Chronic use of topical eye drops is significantly associated with increased lower eyelid laxity. The greatest laxity was observed in patients using preservative-free lubricants for dry eye, suggesting that the mechanical effect of repeated instillation may outweigh potential pharmacologic toxicity.
Clinicians should consider advising patients to minimize mechanical eyelid manipulation during drop instillation. These preliminary findings warrant validation in larger, prospective studies.