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This study investigated potential associations between ectropion and various chronic and systemic inflammatory diseases affecting the eyelids and ocular surface. This retrospective case-control study, spanning 2001-2022, used electronic medical records from Clalit Health Services (CHS) in Israel. Patients diagnosed with involutional ectropion served as the case group, while two control groups were used for comparison: one comprising patients diagnosed with senile cataract and the other with various ophthalmic diseases. Matching for the control groups was performed at a 1:3 ratio based on year of birth, sex, and ethnicity. A total of 17,292 patients with involutional ectropion and 51,876 matched controls in each group were included. The average age of the patients with involutional ectropion was 78 ± 10 years and 58% were men. Significant associations were found between involutional ectropion and several local inflammatory eyelid diseases: blepharitis (OR 4.66), chalazion (OR 2.94), hordeolum (OR 2.26), and dermatitis of the eyelid (OR 2.46). Ocular surface diseases associated with ectropion included chronic conjunctivitis (OR2.89 ) and pterygium (OR 2.48). Systemic diseases such as hypertension (OR 1.46), dyslipidemia (OR 1.45), and autoimmune rheumatic diseases (OR 1.43) were also associated with involutional ectropion. This study found that localized chronic inflammatory conditions affecting the periocular tissues and ocular surface are significantly associated with the development of involutional ectropion., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This retrospective, case-control study was approved by the CHS Research Ethics Committee and the Soroka Medical Center Institutional Review Board (approval number: 0335-22-SOR). The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was waived as the data were obtained retrospectively and anonymized., (© 2025. The Author(s).)

Background: This study investigated the association between involutional ectropion and chronic inflammatory diseases of the eyelid and ocular surface, and other systemic diseases., Methods: This case-control study was conducted using electronic medical records from Clalit Health Services in Israel, 2001-2022. Patients diagnosed with involutional ectropion were compared to two control groups: one with senile cataracts and another with other ophthalmic diseases. The groups were matched 1:3 by birth year, sex, and ethnicity. Mixed models were used to assess differences in demographics, periocular, ocular, and systemic diseases between the groups. Conditional logistic regression was used to estimate the odds ratios (OR) and adjust for confounders., Results: A total of 1786 patients with involutional ectropion and 5358 matched individuals in each control group were included. The average age of the patients with involutional ectropion was 77 ± 10 years, and 60% were men. Significant associations were found between involutional ectropion and several inflammatory diseases: blepharitis (OR 4.25, 95% confidence interval [CI]: 3.68-4.91), chalazion (OR 3.01, 95% CI: 2.3-3.94), hordeolum (OR 2.27, 95% CI: 1.8-2.86), dermatitis of the eyelid (OR 1.69, 95% CI: 1.16-2.47), chronic conjunctivitis (OR 3.49, 95% CI: 2.86-4.26), pterygium (OR 2.21, 95% CI: 1.71-2.86), hypertension (OR 1.5, 95% CI: 1.31-1.72), dyslipidaemia (OR 1.46, 95% CI: 1.3-1.64), and rheumatic disease (OR 1.9, 95% CI: 1.5-2.4)., Conclusions: Periocular, ocular surface, and systemic inflammatory diseases are independent risk factors for involutional ectropion. Further research is necessary to fully understand these associations., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)