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

Purpose: To evaluate whether blepharoptosis is associated with an increased risk of incident falls and fractures among adults. Methods: 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. Results: 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). Conclusions: 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.