Prevalence and risk factors of childhood blepharoptosis in Koreans: the Korea National Health and Nutrition Examination Survey



Childhood blepharoptosis may cause cosmetic and functional problems in children, but there is a paucity of studies about its epidemiology. This study aimed to investigate the prevalence of childhood blepharoptosis and associated risk factors in a representative Korean population.


This cross-sectional nation-wide study analysed the data set acquired from the Korea National Health and Nutrition Examination Survey 2008–2012. A total of 8218 children aged 3–18 years were included. The prevalence of childhood blepharoptosis, defined as a margin reflex distance (MRD) of < 2 mm in either eye, was estimated, and the risk factors were identified using multivariate logistic regression analysis.


The mean age of participants was 11.3 ± 0.1 years, and 52.8 ± 0.6% were boys. The overall prevalence of childhood blepharoptosis in Korea was 8.0% (95% CI, 6.9–9.1%). Boys exhibited a higher prevalence of blepharoptosis than girls at most of ages. Levator function increased with age in the normal general population. The proportion of subjects exhibiting MRD1 ≥ 4.0 mm also increased significantly with age (p < 0.001). Male gender, higher body mass index, and urban residency were significantly associated with childhood blepharoptosis.


The prevalence of childhood blepharoptosis is higher in urban obese boys. The increase of levator function with age should be considered in evaluations of childhood ptosis.

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  1. 1.

    Rha EY, Han K, Park Y, Yoo G. Socioeconomic disparities in the prevalence of blepharoptosis in the South Korean Adult Population Based on a Nationwide Cross-Sectional Study. PLoS ONE. 2016;11:e0145069.

    Article  Google Scholar 

  2. 2.

    Kim MH, Cho J, Zhao D, Woo KI, Kim YD, Kim S, et al. Prevalence and associated factors of blepharoptosis in Korean adult population: The Korea National Health and Nutrition Examination Survey 2008-2011. Eye (Lond). 2017;31:940–6.

    CAS  Article  Google Scholar 

  3. 3.

    Nemet AY, Segal O, Mimouni M, Vinker S. Associated morbidity of pediatric ptosis—a large, community based case-control study. Graefes Arch Clin Exp Ophthalmol. 2014;252:1509–14.

    Article  Google Scholar 

  4. 4.

    Jockin YM. Blepharoptosis in childhood. Int Ophthalmol Clin. 2014;54:55–71.

    Article  Google Scholar 

  5. 5.

    Hashemi H, Nabovati P, Dadbin N, Heidari Z, Yekta A, Jafarzadehpur E, et al. The Prevalence of Ptosis and Its Association with Amblyopia and Strabismus in 7-Year-Old Schoolchildren in Iran. Strabismus. 2015;23:126–31.

    Article  Google Scholar 

  6. 6.

    Ho YF, Wu SY, Tsai YJ. Factors associated with surgical outcomes in congenital ptosis: A 10-year study of 319 cases. Am J Ophthalmol. 2017;175:173–82.

    Article  Google Scholar 

  7. 7.

    Hou D, Li G, Fang L, Li B. Frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children. PLoS ONE. 2013;8:e53185.

    CAS  Article  Google Scholar 

  8. 8.

    Griepentrog GJ, Diehl NN, Mohney BG. Incidence and demographics of childhood ptosis. Ophthalmology. 2011;118:1180–3.

    Article  Google Scholar 

  9. 9.

    Cho BJ, Heo JW, Kim TW, Ahn J, Chung H. Prevalence and risk factors of age-related macular degeneration in Korea: the Korea National Health and Nutrition Examination Survey 2010-2011. Invest Ophthalmol Vis Sci. 2014;55:1101–8.

    Article  Google Scholar 

  10. 10.

    Yoon KC, Choi W, Lee HS, Kim SD, Kim SH, Kim CY, et al. An overview of ophthalmologic survey methodology in the 2008-2015 Korean National Health and Nutrition Examination Surveys. Korean J Ophthalmol. 2015;29:359–67.

    Article  Google Scholar 

  11. 11.

    Paik JS, Jung SK, Han KD, Kim SD, Park YM, Yang SW. Obesity as a POtential Risk Factor for Blepharoptosis: The Korea National Health and Nutrition Examination Survey 2008-2010. PLoS ONE. 2015;10:e0131427.

    Article  Google Scholar 

  12. 12.

    Saonanon P. Update on Asian eyelid anatomy and clinical relevance. Curr Opin Ophthalmol. 2014;25:436–42.

    Article  Google Scholar 

  13. 13.

    Rhee SC, Woo KS, Kwon B. Biometric study of eyelid shape and dimensions of different races with references to beauty. Aesthetic Plast Surg. 2012;36:1236–45.

    Article  Google Scholar 

  14. 14.

    Hreczko T, Farkas LG, Katic M. Clinical significance of age-related changes of the palpebral fissures between age 2 and 18 years in healthy Caucasians. Acta Chir Plast. 1990;32:194–204.

    CAS  PubMed  Google Scholar 

  15. 15.

    Park DH, Jung JM, Song CH. Anthropometric analysis of levator muscle function. Plast Reconstr Surg. 2008;121:1181–7.

    CAS  Article  Google Scholar 

  16. 16.

    Berry-Brincat A, Willshaw H. Paediatric blepharoptosis: a 10-year review. Eye (Lond). 2009;23:1554–9.

    CAS  Article  Google Scholar 

  17. 17.

    Lee V, Konrad H, Bunce C, Nelson C, Collin JR. Aetiology and surgical treatment of childhood blepharoptosis. Br J Ophthalmol. 2002;86:1282–6.

    CAS  Article  Google Scholar 

  18. 18.

    Stein A, Kelly JP, Weiss AH. Congenital eyelid ptosis: onset and prevalence of amblyopia, associations with systemic disorders, and treatment outcomes. J Pediatr. 2014;165:820–22.

    Article  Google Scholar 

  19. 19.

    McMullan TF, Collins AR, Tyers AG, Robinson DO. A novel X-linked dominant condition: X-linked congenital isolated ptosis. Am J Hum Genet. 2000;66:1455–60.

    CAS  Article  Google Scholar 

  20. 20.

    Surve A, Sharma MC, Pushker N, Bajaj MS, Meel R, Kashyap S. A study of changes in levator muscle in congenital ptosis. Int Ophthalmol. 2019;39:1231–8.

  21. 21.

    Baldwin HC, Manners RM. Congenital blepharoptosis: a literature review of the histology of levator palpebrae superioris muscle. Ophthalmic Plast Reconstr Surg. 2002;18:301–7.

    Article  Google Scholar 

  22. 22.

    Leite CP, Schellini SA, Pellizzon CH, Marques ME, Padovani CR. [Congenital ptosis associated with fatty infiltration of levator eyelid muscle]. Arq Bras Oftalmol. 2006;69:827–9.

    Article  Google Scholar 

  23. 23.

    Svechkina A, Dubnov J, Portnov BA. Environmental risk factors associated with low birth weight: The case study of the Haifa Bay Area in Israel. Environ Res. 2018;165:337–48.

    CAS  Article  Google Scholar 

  24. 24.

    Lamichhane DK, Ryu J, Leem JH, Ha M, Hong YC, Park H, et al. Air pollution exposure during pregnancy and ultrasound and birth measures of fetal growth: A prospective cohort study in Korea. Sci Total Environ. 2018;619-620:834–41.

    CAS  Article  Google Scholar 

  25. 25.

    Gong X, Lin Y, Zhan FB. Industrial air pollution and low birth weight: a case-control study in Texas, USA. Environ Sci Pollut Res Int. 2018;25:30375–89.

  26. 26.

    Auger N, Duplaix M, Bilodeau-Bertrand M, Lo E, Smargiassi A. Environmental noise pollution and risk of preeclampsia. Environ Pollut. 2018;239:599–606.

    CAS  Article  Google Scholar 

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We thank the Epidemiologic Survey Committee of the Korean Ophthalmological Society for their dedication to the design and implementation of the Korea National Health and Nutrition Examination Survey, data acquisition and verification, and for allowing public access to the data. This research was supported by the Bio & Medical Technology Development Programme of the National Research Foundation (NRF) and funded by the Korean government (MSIT) (No. NRF-2017M3A9E8033207).


This research was supported by the Bio & Medical Technology Development Programme of the National Research Foundation (NRF) and funded by the Korean government (MSIT) (No. NRF-2017M3A9E8033207).

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Correspondence to Min Joung Lee.

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Cho, BJ., Choi, Y.J., Shin, M.C. et al. Prevalence and risk factors of childhood blepharoptosis in Koreans: the Korea National Health and Nutrition Examination Survey. Eye 34, 1585–1591 (2020).

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