Blepharoptosis and cognitive performance: a population-based study of 1.4 million adolescents

Itay Nitzan, Estela Derazne, Arnon Afek, Zvi Gur, Orly Weinstein, Gilad Twig, Ofira Zloto*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The purpose of this study is to examine the association between blepharoptosis and cognitive performance in late adolescence. This population-based, retrospective, cross-sectional study included 1,411,570 Israeli-born adolescents (620,107 women, 43.9%) aged 16–19 years who were medically examined before compulsory military service between 1993 and 2017. The diagnosis of blepharoptosis was verified by an ophthalmologist. Cognitive performance was assessed by a validated intelligence-quotient-equivalent test, comprising four domains (problem-solving, verbal abstraction and categorization, verbal comprehension, and mathematical abilities). Cognitive Z-scores were calculated and categorized as high (≥ 1 standard deviation (SD)), medium (− 1 to < 1 SD), and low (less than − 1 SD). Relationships were analyzed using regression models adjusted for sociodemographic variables including sex, year of birth, residential socioeconomic status, education level, body mass index, and familial country of origin. A total of 577 (41 per 100,000, 32.2% women) adolescents were diagnosed with blepharoptosis. The proportions of unilateral and bilateral visual impairment among adolescents with blepharoptosis were 13.0% and 3.5%, respectively. In a multivariable analysis, blepharoptosis was associated with a 0.18 SD reduction in cognitive Z-score (p < 0.001). The adjusted odds ratios for low and high cognitive Z-scores in adolescents with blepharoptosis were 1.54 (1.25–1.89) and 0.80 (0.62–1.04), respectively. This relationship persisted when adolescents with normal best-corrected visual acuity or unimpaired health status were analyzed separately. Conclusions: Blepharoptosis is associated with reduced cognitive performance determined in late adolescence. Future prospective studies should investigate the causes of this link and their underlying mechanisms. (Table presented.)

Original languageEnglish
Pages (from-to)235-242
Number of pages8
JournalEuropean Journal of Pediatrics
Issue number1
StatePublished - Jan 2024


  • Adolescents
  • Blepharoptosis
  • Cognitive performance
  • Eyelid
  • Intelligence


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