The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study

The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study Deyi Zhuo, Si Chen, Xiaofang Ren, Bingsong Wang, Linbo Liu, Lin Xiao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-51866/v3 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jan, 2021 Read the published version in BMC Ophthalmology → Version 3 posted 4 You are reading this latest preprint version Show more versions Abstract Background: To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors. Methods: In this population-based, cross-sectional study, a total of 3,170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis. Results: The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6%, 28.0%, 15.0%, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20-1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68-4.33)), myopia (OR = 3.55; 95% CI, (1.86-6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18-1.99)). Conclusions: There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population. Ophthalmology Pediatrics lower eyelid epiblepharon astigmatism myopia refractive error preschool children Figures Figure 1 Figure 2 Background Epiblepharon is an eyelid disorder characterized by a horizontal skinfold that can overlap the eyelid margin, which results in eyelash brushing against the ocular surface 1,2 . This eyelid anomaly usually affects the lower eyelid bilaterally and is reported to be common among East Asian descendants 3 . Although it more commonly involves no or mild symptoms, there are still considerable numbers of patients subject to epiblepharon-related discomforts such as tearing, irritation, and photophobia combined with keratopathy given the ever-increasing Asian populations worldwide 4-6 . Several researchers have attempted to document its prevalence and demographic or clinical characteristics in Asian populations including but not limited to Japanese 3,7 , Korean 8-10 , and Chinese populations 4,5,11,12 . However, to the best of our knowledge, its prevalence in Chinese preschool children is currently unknown. In addition, although the correlation between epiblepharon and refractive errors particularly astigmatism has been previously evaluated 4,5,8-12 , this association has yet to be assessed in the general population since previous researchers retrospectively reviewed clinical data exclusively from epiblepharon patients who sought medical or surgical treatment at local hospitals 4,5,8-12 . In this study, we conducted a population-based study with the aim of exploring the prevalence and demographic characteristics of lower eyelid epiblepharon in Chinese preschool children and assessing its correlation with refractive errors including astigmatism, myopia, and hyperopia. Methods Subjects This was a cross-sectional, school-based study of lower eyelid epiblepharon conducted from July to September 2017 in Xicheng District, a district with approximately 20,000 kindergartners in Beijing. Two-stage stratified cluster sampling was used to select students for study inclusion. In the first stage, 20 kindergartens were randomly selected from 120 kindergartens in Xicheng District. In the second stage, all preschoolers from the 20 kindergartens were selected to undergo health examination at Xicheng Maternal and Child Health Care Hospital. The sample size was calculated to be 3458 with a prevalence rate of 10%, a 1% error rate and a 95% confidence interval based on the study performed by Noda S 3 ..A total of 3721 children aged 3-6 years participated in the study and 3170 of them were included in the data analysis, yielding a completion rate of 85.2%. All participants and their parents or guardians were given full knowledge of the study and written informed consent was obtained from at least one of their parents or guardians. Physical and Eye Examinations All examinations were conducted at room temperature (~ 26-28 °C). The height of the children was measured in meters without shoes, and the weight was measured in kilograms. BMI was calculated as weight in kilograms divided by the square of height in meters. All participants underwent external-eye examination of both eyes by the same ophthalmologist (ZD) using a slit-lamp biomicroscope. Photographs of both eyes were taken using a digital camera against a white background for further diagnosis and classification of epiblepharon. Refractive error was determined by cycloplegic refraction performed with a handheld autorefractor (SureSight ® Autorefractor, Welch Allyn) ≥ 30 mins after cycloplegia which was induced by 3 drops of 1% cyclopentolate (Cyclogyl, Alcon, Belgium) with an interval of 10 mins. For quality control, the autorefractor was calibrated every day prior to data collection and approximately 5% of the children were randomly selected to repeat the refraction test. Definitions of Lower Eyelid Epiblepharon Lower eyelid epiblepharon is diagnosed as a redundant skinfold in the lower eyelid with inverted eyelashes touching the corneal surface, but no inward rotation of the eyelid margin 3 . According to Khwarg’s classification, the severity of skinfold was categorized into 4 classes according to its height and the degree to which it concealed the eyelid margin in the primary eye position 8 ; the severity of cilia-cornea touch was classified into 3 classes according to the area of inverted cilia touching the ocular surface in the primary position (Figure 1) 8 .The children were thereafter considered to have mild epiblepharon if they had any signs of class I, moderate epiblepharon if they demonstrated any signs of class II, and severe epiblepharon if they presented any signs of class III or worse 13 . The diagnosis of lower eyelid epiblepharon was performed independently by two authors (ZD and CS) where disagreement was resolved by discussion with a senior specialist (XL). Definitions of Myopia, Hyperopia and Astigmatism The spherical equivalent (SE) refractive error was expressed as sphere power + ½ × cylinder power. Myopia was defined as SE ≤ −0.50 diopter (D), and hyperopia was defined as SE ≥ +2.00 D. Emmetropia was defined as SE between −0.50 D and +1.00 D, non-inclusive. Astigmatism was defined as a cylindrical refractive error (CYL) of at least 1.50 D with cylindrical refractive error presented as negative correcting cylinder form and was classified into three categories, i.e., with-the-rule astigmatism (WTR; cylinder axis between 1° and 15° or 165° and 180°), against-the-rule astigmatism (ATR; cylinder axis between 75° to 105°), and oblique astigmatism (OBL; cylinder axis between 16° and 74° or 106° and 164°). For children with lower eyelid epiblepharon, if both eyes had equal severity of this condition, refractive error of the right eye was used for analysis; otherwise, the worse eye was selected. For those without epiblepharon, if both eyes had equivalent refractive error, data from the right eye were used for analysis; otherwise, the worse eye was used. Statistical Analysis All the data were imported to Epi-Info version 7.0.9.7 for double-entry customizing, and any differences were resolved by checking with the original data. Chi-square test was employed to analyze the differences in sex, age, and refractive errors between children with and without lower eyelid epiblepharon. Independent samples t-tests were used to compare the differences in height, weight, and BMI between children with and without lower eyelid epiblepharon. One-way analysis of variance (ANOVA) was used to assess the differences in the cylindrical power among astigmatic children with different severities of epiblepharon. Multivariable logistic regression analysis was used to evaluate the factors associated with lower eyelid epiblepharon, and odds ratios (ORs) and the 95% confidence intervals (CIs) were calculated. All analyses were performed using SPSS (version 22, SPSS Inc., Chicago, Illinois), and a two-sided p < 0.05 was considered to be statistically significant. Results There were 1,652 boys and 1,518 girls aged 3-6 years included in the analysis and 551 children were excluded owing to incompletion of the study (n=548), true entropion (n=1) and external hordeolum (n=2). There was no significant difference in age between boys (4.10 ± 0.75 yrs) and girls (4.08 ± 0.76 yrs) of all included subjects (independent samples t-test; p = 0.46). Overall, 26.2% (830 out of 3,170) children had lower eyelid epiblepharon, which could be further grouped into mild (54.3%), moderate (29.6%) and severe (16.1%) classes based on the severity of skin-fold height and cilia-corneal touch (Table 1). Table 1. Classification of lower eyelid epiblepharon Class of cilia-cornea touching Class of skin fold height Total I II III IV I 451 (54.3%) * 84 (10.1%) † 1 (0.1%) ‡ 0 (0%) ‡ 536 (64.5%) II 2 (0.2%) † 160 (19.3%) † 66 (8.0%) ‡ 1 (0.1%) ‡ 229 (27.6%) III 0 (0%) ‡ 3 (0.5%) ‡ 36 (4.3%) ‡ 26 (3.1%) ‡ 65 (7.9%) Total 453 (54.5%) 247 (29.9%) 103 (12.4%) 27 (3.2%) 830 (100%) * Mild epiblepharon † Moderate epiblepharon ‡ Severe epiblepharon Table 2 summarizes the general profile of all included children. Statistically significant differences were detected in sex, age, SE, CYL, astigmatism type (chi-square tests; p = < 0.001, < 0.001, < 0.001, < 0.001, and 0.022, respectively) and BMI (independent samples t-test; p = 0.018) between epiblepharon and nonepiblepharon children (Table 2); no significant differences were identified in either height or weight between these two groups (independent samples t-test; p = 0.303 and 0.413, respectively) (Table 2). Table 2. Characteristics of children with and without lower eyelid epiblepharon Epiblepharon (n=830) No epiblepharon (n=2340) P value Gender, n (%) <0.001 * boys 487 (29.5) 1165 (70.5) girls 343 (22.6) 1175 (77.4) Age (yrs), n (%) <0.001 * 3 152 (30.6) 344 (69.4) 4 601 (28.0) 1547 (72.0) 5 39 (15.0) 221 (85.0) 6 38 (14.3) 228 (85.7) SE (D), n (%) <0.001 * ≤ - 0.5 22 (56.4) 17 (43.6) - 0.5 to 2 713 (25.0) 2141 (75.0) ≥ 2 95 (34.3) 182 (65.7) CYL (D), n (%) <0.001 * 0 to ˂1 541 (22.3) 1890 (77.7) 1 to ˂1.5 132 (30.6) 300 (69.4) 1.5 to ˂2 68 (43.0) 90 (57.0) 2 to <2.5 44 (57.1) 33 (42.9) 2.5 to 3.0 13 (56.5) 10 (43.5) Astigmatism type, n (%) 0.022 * WTR 127 (52.3) 112 (47.4) ATR 7 (35.5) 20 (64.5) OBL 23 (56.1) 18 (43.9) Height (ms), mean (SD) 1.01 (0.07) 1.01 (0.07) 0.303 Weight (kgs), mean (SD) 15.72 (2.92) 15.63 (2.73) 0.413 BMI, mean (SD) 15.43 (1.83) 15.26 (1.69) 0.018 * * p is statistically significant at 5%. BMI: body mass index, SD: standard deviation, CI: confidence interval, SE: spherical equivalent refractive error, CYL: cylindrical refractive error, D: diopters, WTR: with-the-rule, ATR: against-the-rule, OBL: oblique. The prevalence of lower eyelid epiblepharon based on age was 30.6%, 28.0%, 15.0%, and 14.3% for 3-, 4-, 5-, and 6-year-old children, respectively (Table 2). Figure 2 further illustrates the age-specific prevalence of lower eyelid epiblepharon by its severity according to criteria based on skin-fold height only (Figure 2A), cilia-cornea touching area only (Figure 2B), and criteria established by both (Figure 2C). At different degrees of severity, younger patients roughly demonstrated a higher prevalence of epiblepharon than older patients (Figure 2). Lower Eyelid Epiblepharon Associated Risk Factors As statistically significant differences in age, sex and BMI were detected between children with and without lower eyelid epiblepharon (Table 2), multivariable logistic regression analysis was performed to further evaluate the association between lower eyelid epiblepharon and these three variables to screen for the risk factors for this eyelid disorder (Table 3). After adjustment for potential confounders including age, sex and BMI, epiblepharon was significantly associated with sex and age. Specifically, boys were more likely to have epiblepharon than girls (OR = 1.41 with p < 0.001); younger children at 3, 4, and 5 years old demonstrated higher possibilities of having epiblepharon than older children (6 years old), although no statistically significant difference was identified between 5- and 6-year-old children (OR = 3.68, 2.95, and 1.24 with p = < 0.001, < 0.001 and 0.402, respectively). However, after adjusting for sex and age, the association between BMI and epiblepharon was no longer statistically significant (p = 0.062). Table 3. Association between lower eyelid epiblepharon and age, gender, and BMI Risk factors OR 95%CI p value Gender Boys vs girls 1.41 (1.20, 1.66) P< 0.001 Age(yrs) 3 vs 6 3.68 (2.38, 5.68) p < 0.001 4 vs 6 2.95 (2.01, 4.32) p < 0.001 5 vs 6 1.24 (0.75, 2.03) p = 0.402 BMI 1.07 (0.95, 1.15) p = 0.062 OR = odds ratio, CI = confidential interval. Relation between Lower Eyelid Epiblepharon and Refractive Errors Astigmatism (CYL ≥ 1.5 D) was identified in 307 children (9.68%) and 157 of them had epiblepharon. A statistically significantly higher prevalence of astigmatism was detected in epiblepharon children than in nonepiblepharon children (18.9% vs 6.4%) (chi-square test; p < 0.001). Meanwhile, in both populations, the astigmatism type was largely WTR (80.9% for epiblepharon vs 74.7% for nonepiblepharon). Myopia (SE ≤ -0.5 D) was recognized in 39 children (1.23%) with 22 of them having epiblepharon; hyperopia (SE ≥ 2 D) was found in 277 children (8.74%) with 95 of them being epiblepharon-positive. Higher prevalences of myopia (2.7% vs 0.7%) and hyperopia (11.4% vs 7.8%) were identified in epiblepharon children than in nonepiblepharon children (chi-square tests; p = < 0.01 and 0.002, respectively). To further evaluate the association between lower eyelid epiblepharon and refractive errors, multivariable logistic regression analysis was performed where age and sex were adjusted for (Table 4). Overall, epiblepharon children presented an increased risk of astigmatism relative to nonepiblepharon children (OR = 3.41; 95% CI, (2.68, 4.33)), and epiblepharon preschoolers had a higher risk of myopia (OR = 3.55; 95% CI, (1.86, 6.76)) and hyperopia (OR = 1.53 95% CI, (1.18, 1.99)) than nonepiblepharon children. Table 4. Association between lower eyelid epiblepharon and refractive errors Astigmatism(≥1.5D) Myopia(≤-0.5D) Hyperopia(≥2.0D) OR (95%CI) P value OR (95%CI) P value OR (95%CI) P value No Epiblepharon 1.00 (ref) 1.00 (ref) 1.00 (ref) Epiblepharon Mild 3.15 (2.35, 4.22) <0.001 4.38 (2.14, 8.95) <0.001 1.51 (1.09, 2.10) 0.014 Moderate 3.82 (2.69, 5.42) <0.001 4.00 (1.64, 9.75) 0.002 1.52 (1.00, 2.32) 0.050 Severe 3.55 (2.24, 5.62) <0.001 - - 1.62 (0.94, 2.79) 0.082 ALL 3.41 (2.68, 4.33) <0.001 3.55 (1.86, 6.76) <0.001 1.53 (1.18, 1.99) 0.001 OR: odd ratio, WTR: with the rule, OBL: oblique. Discussion This population-based cross-sectional study investigated the prevalence and demographics of lower eyelid epiblepharon and explored its correlation with refractive errors in 3- to 6-year-old Chinese children. To the best of our knowledge, our study is the first to reveal the prevalence of this eyelid disorder in Chinese preschoolers and analyzes the relationship between epiblepharon and refractive errors including not only astigmatism but also myopia and hyperopia. We observed a prevalence of 26.2% in 3- to 6-year-old Chinese children, much higher than that of Noda S. et al.’s study in Japanese children, where 13.8% of 766 children were diagnosed with epiblepharon 3 . The relatively lower prevalence in Noda’s study is possibly because they adopt relatively stricter criteria for disease diagnosis where the widely accepted Khwarg’s classification has yet to be established. In Noda’s study, cilia-cornea touching was confirmed only when the cornea was positively stained after topical fluorescein staining, whereas later studies by Khwang S. et al and Young S. et al indicated that a considerable number of epiblepharon patients (usually those with mild epiblepharon) may not have the ocular manifestation of corneal erosion that could be stained with fluorescein 8,13 . In addition, when we excluded children with mild epiblepharon, the prevalence decreased to 11.9%, which was similar to the 13.8% reported in Noda’s study. Given such a high prevalence in Asian infants and children, deducing the demographic characteristics of epiblepharon is helpful for a better understanding of this eyelid disorder. To date, limited data are available from either observations of the general population 3,7 or retrospective data from patients who underwent surgical treatment 4 . Consistent with previous studies 3,4,7 , our results in Chinese preschool children show that younger individuals have a higher risk of epiblepharon, supporting the widely-accepted hypothesis that epiblepharon tends to disappear spontaneously with aging as facial bone growth in Asians 6 . However, there are discrepancies in BMI and the sexual predilection between our study and others. Different from results in Japanese and Singaporeans where no sexual predilection was recognized 3,4,7 , the present study demonstrates that boys are subject to a higher risk of having lower eyelid epiblepharon than girls with an adjusted OR = 1.41 in the logistic regression model. Differences in the diagnostic criteria 3 , subjects’ age range 7 , epiblepharon severity, and possible sample selection bias in a clinic-based study 4 may all contribute to the discrepancy in sex predilection between our study and others. Although lower eyelid epiblepharon trends to resolve spontaneously with aging, its occurrence during the critical period of visual development makes it crucial to disclose if it is correlated with refractive errors, which may ultimately lead to permanent visual impairment such as amblyopia or retinopathy 14-17 . In this study, the prevalence of astigmatism was 9.68%, similar to previous studies in Asian infants and preschoolers 18-20 , and, in those with lower eyelid epiblepharon, the prevalence could be as high as 18.9%. We demonstrate for the first time that epiblepharon children are subject to a significantly higher risk of astigmatism, largely being WTR in the general population, and these findings agree well with previous retrospective studies in patients 9,11,12 . In addition, we also evaluated the relationship between lower eyelid epiblepharon and spherical refractive errors, i.e., myopia and hyperopia. These epiblepharon preschoolers were 3.55 times as likely to have myopia as those without epiblepharon, and 1.53 times as likely to have hyperopia. The significantly increased risk of myopia in epiblepharon children agrees with the observations in clinical patients that severe myopia is commonly accompanied by a large number of cilia touching the cornea 9 . However, considering the relatively small sample size (22 out of 39 epiblepharon preschoolers being myopic) and absence of severe myopia (-2.75 D to -0.5 D), further study with a larger sample size should be conducted to further validate the association between epiblepharon and myopia. The strength of this study lies in the fact that the demographics of epiblepharon and its association with refractive errors are evaluated in the Chinese preschool population with by far the largest sample size thus far reported. Nevertheless, there are several limitations in this study. First, the children included in this study were all enrolled from urban areas, which may result in bias from sample selection. Further studies ideally from multiple centers including children from both rural and urban area would improve our understanding of the risk factors related to lower eyelid epiblepharon and its association with refractive errors. Second, the prevalence of epiblepharon may be underestimated because epiblepharon can be missed in children whose cilia touch the cornea only in downward gaze but not in primary gaze. Another limitation is that we used only the skinfold height and the cilia-cornea touching area as criteria for the diagnosis of lower eyelid epiblepharon without considering areas of corneal erosion. However, owing to concerns about the risk of the fluorescein dying procedure and limited time allowance in a screening circumstance, an approach that is both safe and simple must be adopted; in addition, this limitation can be mitigated since there is high agreement among the three criteria for the diagnosis of epiblepharon 8 . In addition, our conclusion may be affected by type 1 error as multiple comparisons were conducted. Conclusions Our study demonstrates a relatively high prevalence of lower eyelid epiblepharon in Chinese preschoolers, particularly in boys and young children, and shows that there are significant correlations between lower eyelid epiblepharon and refractive errors, including astigmatism, myopia, and hyperopia. Given such a high prevalence combined with the increased risk for refractive errors, it would be of great significance to be aware of the necessity and importance to establish an effective screening strategy for this disease, to conduct a closer follow-up of the clinical manifestations of involved children and to consider giving early interventions and visual rehabilitation when warranted. Abbreviations AORs: adjusted odds ratios ORs: odds ratios CIs: confidence intervals BMI: body mass index SD: standard deviation SE: spherical equivalent refractive error CYL: cylindrical refractive error WTR: with-the-rule ATR: against-the-rule OBL: oblique Declarations Ethics Approval and Consent to Participate All procedures conformed to the tenets of the declaration of Helsinki and written informed consent was obtained from the parents or guardians of the participants. The Ethics Committee of Beijing Shijitan Hospital approved the study (2017 Research ethics NO.69, Beijing Shijitan Hospital, Affiliated to Capital Medical University, 2017-5-20). Consent for publication Not applicable. Availability of Data and Material The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests No authors have conflict of interest to declare. Funding This study was supported by the Ministry of Education Singapore under its Academic Research Fund Tier 1 (2018-T1-001-144), Agency for Science, Technology and Research (A*STAR) under its Industrial Alignment Fund (Pre-positioning) (H17/01/a0/008), National Medical Research Council Singapore under its Open Fund - Individual Research Grant (MOH-OFIRG19may-0009), and Beijing Shijitan Hospital, Capital Medical University under its Hospital Fund (2017-C07). The Funding sponsors were not involved in the study design, data analysis, results interpretation, or manuscript writing. Authors’ Contributions XL and LL designed and supervised this study. ZD, CS and RX collected data. ZD, CS and LL conducted data analysis and interpretation. CS and ZD drafted the manuscript. RX, WB, and XL provided administrative, technical, and material support for this study. All authors have read and approved the manuscript. Acknowledgements We thank all subjects for participating in this study. References Johnson CC. Epiblepharon. American journal of ophthalmology. Dec 1968;66(6):1172-1175. Lemke BN, Stasior OG. Epiblepharon. An important and often missed diagnosis. Clinical pediatrics. Oct 1981;20(10):661-662. Noda S, Hayasaka S, Setogawa T. Epiblepharon with inverted eyelashes in Japanese children. I. Incidence and symptoms. Br J Ophthalmol. Feb 1989;73(2):126-127. Sundar G, Young SM, Tara S, Tan AM, Amrith S. 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Clinical & experimental optometry. Jan 2007;90(1):5-19. Supplementary Files STROBEchecklistcrosssectional1.doc Cite Share Download PDF Status: Published Journal Publication published 04 Jan, 2021 Read the published version in BMC Ophthalmology → Version 3 posted Editorial decision: Accept 27 Nov, 2020 Editor assigned by journal 24 Nov, 2020 Submission checks completed at journal 24 Nov, 2020 Editor invited by journal 24 Nov, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-51866","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":5412616,"identity":"dbd99af5-95ae-44be-8bbe-e1df4957d8ab","order_by":0,"name":"Deyi Zhuo","email":"","orcid":"https://orcid.org/0000-0002-5267-2664","institution":"Capital Medical University Affiliated Beijing Shijitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Deyi","middleName":"","lastName":"Zhuo","suffix":""},{"id":5412617,"identity":"1f42eb35-8c8c-4cfc-b0dd-45787847b6d1","order_by":1,"name":"Si Chen","email":"","orcid":"","institution":"Nanyang Technological University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Si","middleName":"","lastName":"Chen","suffix":""},{"id":5412618,"identity":"af8d3374-b9a0-4f21-a008-b6c883b9c643","order_by":2,"name":"Xiaofang Ren","email":"","orcid":"","institution":"Capital Medical University Affiliated Beijing Shijitan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaofang","middleName":"","lastName":"Ren","suffix":""},{"id":5412619,"identity":"89336394-a2c8-4ed7-b604-9f88273e8351","order_by":3,"name":"Bingsong Wang","email":"","orcid":"","institution":"Beijing Tongren Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bingsong","middleName":"","lastName":"Wang","suffix":""},{"id":5412620,"identity":"171eb14b-9668-4e05-bda2-2ded0fb6ab1b","order_by":4,"name":"Linbo Liu","email":"","orcid":"","institution":"Nanyang Technological University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Linbo","middleName":"","lastName":"Liu","suffix":""},{"id":5412621,"identity":"b99d1056-9ca2-4e9c-a058-90831d585a36","order_by":5,"name":"Lin Xiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYDACZiB+YMDAwy9//uMDIDuBOC0JBgwykjMYjA2gWhgbCGoDKrMxuMFgJkGUFoPjzA8fJBTc4TG43ZBWzVNhl8cg3Xz8AT4tks1sxgYJBs94JO8cOHab50xyMYPMsUS8tvAzA92TYHCYh+9AYttt3jbmxAaJHEO8WtiY2b+BtTAcSGYr5v1XD9SS/5GALTwQWwRupLEx8zYcBtmC3/uSzTzFBiAtkj1nmCXnHDue2CaRZjgDnxaD88c3Pvjw57A9P3sP44c3NdWJ/RLJDz7g04ICmHhAviNaOQgw/iBJ+SgYBaNgFIwUAACb80nHPd7baQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-2486-6506","institution":"Beijing Shijitan Hospital, Capital University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2020-07-31 12:13:04","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-51866/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-51866/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-020-01749-7","type":"published","date":"2021-01-04T15:01:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4071430,"identity":"7d61e190-f9f2-41df-ae4f-6a05eb24d2ac","added_by":"auto","created_at":"2020-12-07 16:24:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74790,"visible":true,"origin":"","legend":"Classification of lower eyelid epiblepharon.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-51866/v3/5f1748f31e7d415ce2e012a4.jpg"},{"id":4071432,"identity":"79e9fcf1-f1a3-4b74-bb2f-f9c5749da37b","added_by":"auto","created_at":"2020-12-07 16:24:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":105027,"visible":true,"origin":"","legend":"Age-specific prevalence of lower eyelid epiblepharon by its severity. Epiblepharon classified by skinfold height (A), cilia-cornea touching area (B), and both skinfold height and cilia-cornea touching area (C). ","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-51866/v3/c3c0c1e4cff6aa21838e5ba9.jpg"},{"id":13624239,"identity":"64aaf3ab-2df1-4c68-863e-31c60d7fe7ba","added_by":"auto","created_at":"2021-09-17 07:21:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":594155,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-51866/v3/3367a354-fa56-4f45-818b-1dbab923d722.pdf"},{"id":4071431,"identity":"e6cefaef-7763-426b-a4ce-d3df65c5c232","added_by":"auto","created_at":"2020-12-07 16:24:02","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":84480,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistcrosssectional1.doc","url":"https://assets-eu.researchsquare.com/files/rs-51866/v3/3bbee282ca2465c13248af19.doc"}],"financialInterests":"","formattedTitle":"The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eEpiblepharon is an eyelid disorder characterized by a horizontal skinfold that can overlap the eyelid margin, which results in eyelash brushing against the ocular surface\u003csup\u003e1,2\u003c/sup\u003e. This eyelid anomaly usually affects the lower eyelid bilaterally and is reported to be common among East Asian descendants\u003csup\u003e3\u003c/sup\u003e. Although it more commonly involves no or mild symptoms, there are still considerable numbers of patients subject to epiblepharon-related discomforts such as tearing, irritation, and photophobia combined with keratopathy given the ever-increasing Asian populations worldwide\u003csup\u003e4-6\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral researchers have attempted to document its prevalence and demographic or clinical characteristics in Asian populations including but not limited to Japanese\u003csup\u003e3,7\u003c/sup\u003e, Korean\u003csup\u003e8-10\u003c/sup\u003e, and Chinese populations\u003csup\u003e4,5,11,12\u003c/sup\u003e. However, to the best of our knowledge, its prevalence in Chinese preschool children is currently unknown. In addition, although the correlation between epiblepharon and refractive errors particularly astigmatism has been previously evaluated\u003csup\u003e4,5,8-12\u003c/sup\u003e,\u0026nbsp;this association has yet to be assessed in the general population since previous researchers retrospectively reviewed clinical data exclusively from epiblepharon patients who sought medical or surgical treatment at local hospitals\u003csup\u003e4,5,8-12\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn this study, we conducted a population-based study with the aim of exploring the prevalence and demographic characteristics of lower eyelid epiblepharon in Chinese preschool children and assessing its correlation with refractive errors including astigmatism, myopia, and hyperopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSubjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;was\u0026nbsp;a cross-sectional, school-based study of lower eyelid epiblepharon conducted from July to September 2017 in Xicheng District, a\u0026nbsp;district\u0026nbsp;with approximately\u0026nbsp;20,000\u0026nbsp;kindergartners\u0026nbsp;in\u0026nbsp;Beijing. Two-stage stratified cluster sampling was used to select students for study inclusion. In the first stage, 20 kindergartens were randomly selected from 120 kindergartens in Xicheng District. In the second stage, all preschoolers from the 20 kindergartens were selected to undergo health examination at Xicheng Maternal and Child Health Care Hospital. The sample size was calculated to be 3458 with a prevalence rate of 10%, a 1% error rate and a 95% confidence interval based on the study performed by Noda S\u003csup\u003e3\u003c/sup\u003e..A total of 3721 children aged 3-6 years participated\u0026nbsp;in\u0026nbsp;the study and 3170 of them were included in the data analysis, yielding a completion rate of 85.2%. All participants and their parents or guardians were given full knowledge of the study and written informed consent was obtained from at least one of their parents or guardians.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical and Eye Examinations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll examinations were conducted at room temperature (~ 26-28 \u0026deg;C). The height of the children was measured in meters without shoes, and the weight was measured in kilograms. BMI was calculated as weight in kilograms divided by the square of height in meters.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants underwent external-eye examination of both eyes by the same ophthalmologist (ZD) using a slit-lamp biomicroscope. Photographs of both eyes were taken using a digital camera against a white background for further diagnosis and classification of epiblepharon. Refractive error was determined by cycloplegic refraction performed with a handheld autorefractor (SureSight\u003csup\u003e\u0026reg;\u003c/sup\u003e Autorefractor, Welch Allyn) \u0026ge; 30 mins after cycloplegia which was induced by 3 drops of 1% cyclopentolate (Cyclogyl, Alcon, Belgium) with an interval of 10 mins. For quality control, the autorefractor\u0026nbsp;was\u0026nbsp;calibrated every day prior to data collection and approximately 5% of the\u0026nbsp;children\u0026nbsp;were randomly selected to repeat the refraction test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions of Lower Eyelid Epiblepharon\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLower eyelid epiblepharon is diagnosed as a redundant skinfold in the lower eyelid with inverted eyelashes touching the corneal surface, but no inward rotation of the eyelid margin\u003csup\u003e3\u003c/sup\u003e.\u0026nbsp;According to Khwarg\u0026rsquo;s classification, the severity of skinfold was categorized into 4 classes according to its height and the degree to which it concealed the eyelid margin in the primary eye position\u003csup\u003e8\u003c/sup\u003e; the severity of cilia-cornea touch was classified into 3 classes according to the area of inverted cilia touching the ocular surface in the primary position (Figure 1)\u003csup\u003e8\u003c/sup\u003e.The children were thereafter considered to have mild epiblepharon if they had any signs of class I,\u0026nbsp;moderate epiblepharon if they demonstrated any signs of class II,\u0026nbsp;and severe epiblepharon if they presented any signs of class\u0026nbsp;III or worse\u003csup\u003e13\u003c/sup\u003e. The diagnosis of lower eyelid epiblepharon was performed independently by two authors (ZD and CS) where disagreement was resolved by discussion with a senior specialist (XL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions of Myopia, Hyperopia and Astigmatism\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe spherical equivalent (SE) refractive error was expressed as sphere power + \u0026frac12; \u0026times; cylinder power. Myopia was defined as SE \u0026le;\u0026nbsp;\u0026minus;0.50 diopter (D), and hyperopia was defined as SE \u0026ge; +2.00 D. Emmetropia was defined as SE between\u0026nbsp;\u0026minus;0.50 D and +1.00 D, non-inclusive. Astigmatism was defined as a cylindrical refractive error (CYL) of at least 1.50 D with cylindrical refractive error presented as negative correcting cylinder form and was classified into three categories, i.e., with-the-rule astigmatism (WTR; cylinder axis between 1\u0026deg; and 15\u0026deg; or 165\u0026deg; and 180\u0026deg;), against-the-rule astigmatism (ATR; cylinder axis between 75\u0026deg; to 105\u0026deg;), and oblique astigmatism (OBL; cylinder axis between 16\u0026deg; and 74\u0026deg; or 106\u0026deg; and 164\u0026deg;). For children with lower eyelid epiblepharon, if both eyes had equal severity of this condition, refractive error of the right eye was used for analysis; otherwise, the worse eye was selected. For those without epiblepharon, if both eyes had equivalent refractive error, data from the right eye were used for analysis; otherwise, the worse eye was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data were imported to Epi-Info version 7.0.9.7 for double-entry customizing, and any differences were resolved by checking with the original data. Chi-square test was\u003csup\u003e\u0026nbsp;\u003c/sup\u003eemployed to analyze the differences in sex, age, and refractive errors between children with and without lower eyelid epiblepharon. Independent samples t-tests were used to compare the differences in height, weight, and BMI between children with and without lower eyelid epiblepharon. One-way analysis of variance (ANOVA) was used to assess the differences in the cylindrical power among astigmatic children with different severities of epiblepharon. Multivariable logistic regression analysis was used to evaluate the factors associated with lower eyelid epiblepharon, and odds ratios (ORs) and the 95% confidence intervals (CIs) were calculated. All analyses were performed using SPSS (version 22, SPSS Inc., Chicago, Illinois), and a two-sided p \u0026lt; 0.05 was considered to be statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 1,652 boys and 1,518 girls aged 3-6 years included in the analysis and 551 children were excluded owing to incompletion of the study (n=548), true entropion (n=1) and external hordeolum (n=2). There was no significant difference in age between boys (4.10 \u0026plusmn; 0.75 yrs) and girls (4.08 \u0026plusmn; 0.76 yrs) of all included subjects (independent samples t-test; p = 0.46). Overall, 26.2% (830 out of 3,170) children had lower eyelid epiblepharon, which could be further grouped into mild (54.3%), moderate (29.6%) and severe (16.1%) classes based on the severity of skin-fold height and cilia-corneal touch (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eTable 1.\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp; Classification of lower eyelid epiblepharon\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003ctable style=\"width:415.6pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eClass of cilia-cornea touching\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" style=\"width: 281.45pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eClass of skin fold height\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:58.35pt;border-top:solid #7F7F7F 1.0pt;border-left: none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eII\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eIII\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eIV\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 0.85in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75.8pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003eI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e451 (54.3%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e84 (10.1%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 65.2pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e1 (0.1%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 62.35pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e0 (0%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 65.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e536 (64.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003eII\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;color:black;'\u003e2 (0.2%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;color:black;'\u003e160 (19.3%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 65.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;color:black;'\u003e66 (8.0%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 62.35pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;color:black;'\u003e1 (0.1%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 65.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e229 (27.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75.8pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003eIII\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e0 (0%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e3 (0.5%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 65.2pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e36 (4.3%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 62.35pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:black;'\u003e26 (3.1%)\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e\u0026Dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 65.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e65 (7.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75.8pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003eTotal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e453 (54.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e247 (29.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 65.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e103 (12.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 62.35pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e27 (3.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 65.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e830 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable style=\"width: 100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:8.35pt;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-family: \"Arial\",sans-serif;'\u003e* Mild epiblepharon\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable style=\"width: 100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:2.85pt;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:5.5pt;'\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background: white;'\u003e\u0026dagger;\u0026nbsp;\u003c/span\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eModerate epiblepharon\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable style=\"width: 100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:2.85pt;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-indent:5.5pt;'\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background: white;'\u003e\u0026Dagger;\u0026nbsp;\u003c/span\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eSevere epiblepharon\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Table 2 summarizes the general profile of all included children. Statistically significant differences were detected in sex, age, SE, CYL, astigmatism type (chi-square tests; \u003cem\u003ep\u003c/em\u003e = \u0026lt; 0.001, \u0026lt; 0.001, \u0026lt; 0.001, \u0026lt; 0.001, and 0.022, respectively) and BMI (independent samples t-test; \u003cem\u003ep\u003c/em\u003e = 0.018) between epiblepharon and nonepiblepharon children (Table 2); no significant differences were identified in either height or weight between these two groups (independent samples t-test; \u003cem\u003ep\u003c/em\u003e = 0.303 and 0.413, respectively) (Table 2). \u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eTable 2. \u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eCharacteristics of children with and without lower eyelid epiblepharon\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eEpiblepharon\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(n=830)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eNo epiblepharon\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(n=2340)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eGender, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eboys\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e487 (29.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130.95pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e1165 (70.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003egirls\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e343 (22.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e1175 (77.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eAge (yrs), n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e152 (30.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e344 (69.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e4\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e601 (28.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e1547 (72.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e5\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e132 (30.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e300 (69.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e1.5 to ˂2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e68 (43.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e90 (57.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e2 to \u0026lt;2.5\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e44 (57.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e33 (42.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e2.5 to \u0026lt;3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e32 (65.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e17 (34.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026gt;3.0\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e13 (56.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e10 (43.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eAstigmatism type, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e0.022\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eWTR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e127 (52.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e112 (47.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e7 (35.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e20 (64.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:14.15pt;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eOBL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e23 (56.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e18 (43.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eHeight (ms), mean (SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;color:black;'\u003e1.01 (0.07)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;color:black;'\u003e1.01 (0.07)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e0.303\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eWeight (kgs), mean (SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e15.72 (2.92)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e15.63 (2.73)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e0.413\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:127.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eBMI, mean (SD)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e15.43 (1.83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:130.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family: \"Arial\",sans-serif;'\u003e15.26 (1.69)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:64.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;0.018\u003c/span\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-family:\"Helvetica\",sans-serif;color:#1C1C1C;background:white;'\u003e*\u003c/span\u003e\u003cem\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;is statistically significant at 5%. BMI: body mass index, SD: standard deviation, CI:\u003c/span\u003e\u003cspan style=\"font-size:13px;line-height:107%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Arial\",sans-serif;'\u003econfidence interval, SE: spherical equivalent refractive error, CYL: cylindrical refractive error, D: diopters, WTR: with-the-rule, ATR: against-the-rule, OBL: oblique.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of lower eyelid epiblepharon based on age was 30.6%, 28.0%, 15.0%, and 14.3% for 3-, 4-, 5-, and 6-year-old children, respectively (Table 2). Figure 2 further illustrates the age-specific prevalence of lower eyelid epiblepharon by its severity according to criteria based on skin-fold height only (Figure 2A), cilia-cornea touching area only (Figure 2B), and criteria established by both (Figure 2C). At different degrees of severity, younger patients roughly demonstrated a higher prevalence of epiblepharon than older patients (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLower Eyelid Epiblepharon Associated Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs statistically significant differences in age, sex and BMI were detected between children with and without lower eyelid epiblepharon (Table 2), multivariable logistic regression analysis was performed to further evaluate the association between lower eyelid epiblepharon and these three variables to screen for the risk factors for this eyelid disorder (Table 3). After adjustment for potential confounders including age, sex and BMI, epiblepharon was significantly associated with sex and age. Specifically, boys were more likely to have epiblepharon than girls (OR = 1.41 with p \u0026lt; 0.001); younger children at 3, 4, and 5 years old demonstrated higher possibilities of having epiblepharon than older children (6 years old), although no statistically significant difference was identified between 5- and 6-year-old children (OR = 3.68, 2.95, and 1.24 with p = \u0026lt; 0.001, \u0026lt; 0.001 and 0.402, respectively). However, after adjusting for sex and age, the association between BMI and epiblepharon was no longer statistically significant (p = 0.062).\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eTable 3.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eAssociation between lower eyelid epiblepharon and age, gender, and BMI\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eRisk factors\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eOR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e95%CI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003ep value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eGender\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eBoys vs girls\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.41\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(1.20, 1.66)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003eP\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eAge(yrs)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e3 vs 6\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e3.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(2.38, 5.68)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003ep \u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e4 vs 6\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e2.95\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(2.01, 4.32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003ep \u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e5 vs 6\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(0.75, 2.03)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003ep = 0.402\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121.25pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eBMI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.1pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e1.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103.2pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(0.95, 1.15)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.75pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003ep = 0.062\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003eOR = odds ratio, CI = confidential interval.\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelation between Lower Eyelid Epiblepharon and Refractive Errors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAstigmatism (CYL \u0026ge; 1.5 D) was identified in 307 children (9.68%) and 157 of them had epiblepharon. A statistically significantly higher prevalence of astigmatism was detected in epiblepharon children than in nonepiblepharon children (18.9% vs 6.4%) (chi-square test; p \u0026lt; 0.001). Meanwhile, in both populations, the astigmatism type was largely WTR (80.9% for epiblepharon vs 74.7% for nonepiblepharon).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMyopia (SE \u0026le; -0.5 D) was recognized in 39 children (1.23%) with 22 of them having epiblepharon; hyperopia (SE \u0026ge; 2 D) was found in 277 children (8.74%) with 95 of them being epiblepharon-positive. Higher prevalences of myopia (2.7% vs 0.7%) and hyperopia (11.4% vs 7.8%) were identified in epiblepharon children than in nonepiblepharon children (chi-square tests; p = \u0026lt; 0.01 and 0.002, respectively). To further evaluate the association between lower eyelid epiblepharon and refractive errors, multivariable logistic regression analysis was performed where age and sex were adjusted for (Table 4). Overall, epiblepharon children presented an increased risk of astigmatism relative to nonepiblepharon children (OR = 3.41; 95% CI, (2.68, 4.33)), and epiblepharon preschoolers had a higher risk of myopia (OR = 3.55; 95% CI, (1.86, 6.76)) and hyperopia (OR = 1.53 95% CI, (1.18, 1.99)) than nonepiblepharon children.\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eTable 4.\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;color:red;'\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eAssociation between lower eyelid epiblepharon and refractive errors\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 105.75pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003eAstigmatism(\u0026ge;1.5D)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109.4pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003eMyopia(\u0026le;-0.5D)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 108.3pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003eHyperopia(\u0026ge;2.0D)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid rgb(127, 127, 127);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.7pt;border:none;border-bottom:solid #7F7F7F 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eOR (95%CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.05pt;border:none;border-bottom:solid #7F7F7F 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:62.5pt;border:none;border-bottom:solid #7F7F7F 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eOR (95%CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.9pt;border:none;border-bottom:solid #7F7F7F 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:62.5pt;border:none;border-bottom:solid #7F7F7F 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eOR (95%CI)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.8pt;border:none;border-bottom:solid #7F7F7F 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eNo Epiblepharon\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 105.75pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.00 (ref)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.00 (ref)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 108.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.00 (ref)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eEpiblepharon \u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 323.45pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eMild\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.7pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e3.15\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(2.35, 4.22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.05pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e4.38\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(2.14, 8.95)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.9pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.51\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(1.09, 2.10)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.8pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e0.014\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eModerate\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.7pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e3.82\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(2.69, 5.42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.05pt;border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.5pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e4.00\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(1.64, 9.75)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.9pt;border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e0.002\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.5pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e1.52\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(1.00, 2.32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.8pt;border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e0.050\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eSevere\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.7pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e3.55\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(2.24, 5.62)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.05pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:62.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:46.9pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e1.62\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height: 200%;font-family:\"Arial\",sans-serif;'\u003e(0.94, 2.79)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.8pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e0.082\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92.15pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003eALL\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.7pt;border-top: 1pt solid rgb(127, 127, 127);border-left: none;border-bottom: 1pt solid rgb(127, 127, 127);border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e3.41\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(2.68, 4.33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:47.05pt;border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan 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\u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e(1.18, 1.99)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.8pt;border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin-top:6.0pt;margin-right:0in;margin-bottom: 0in;margin-left:0in;line-height:200%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;line-height:200%;font-family:\"Arial\",sans-serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOR: odd ratio, WTR:\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Arial\",sans-serif;'\u003ewith the rule, OBL: oblique.\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis population-based cross-sectional study investigated the prevalence and demographics of lower eyelid epiblepharon and explored its correlation with refractive errors in 3- to 6-year-old Chinese children. To the best of our knowledge,\u0026nbsp;our\u0026nbsp;study is the first to reveal the prevalence of this eyelid disorder in Chinese preschoolers and analyzes the relationship between epiblepharon and refractive errors including not only astigmatism but also myopia and hyperopia. We observed a prevalence of 26.2% in 3- to 6-year-old Chinese children, much higher than\u0026nbsp;that\u0026nbsp;of\u0026nbsp;Noda S. et al.\u0026rsquo;s study in Japanese children, where 13.8% of 766 children were diagnosed with epiblepharon\u003csup\u003e3\u003c/sup\u003e. The relatively lower prevalence in Noda\u0026rsquo;s study is possibly because they adopt relatively stricter\u0026nbsp;criteria for disease diagnosis\u0026nbsp;where\u0026nbsp;the widely accepted Khwarg\u0026rsquo;s classification has yet to be established. In Noda\u0026rsquo;s study, cilia-cornea touching was confirmed only when the cornea\u0026nbsp;was\u0026nbsp;positively stained after topical fluorescein staining, whereas later studies by Khwang S. et al and Young S. et al indicated that a considerable number of epiblepharon patients (usually those with mild epiblepharon) may not have the ocular manifestation of corneal erosion that could be stained with fluorescein\u003csup\u003e8,13\u003c/sup\u003e.\u0026nbsp;In\u0026nbsp;addition,\u0026nbsp;when we excluded children with mild epiblepharon, the prevalence decreased to 11.9%, which was similar to the 13.8% reported in Noda\u0026rsquo;s study.\u003c/p\u003e\n\u003cp\u003eGiven such a high prevalence in Asian infants and children, deducing the demographic characteristics of epiblepharon is helpful for a better understanding of this eyelid disorder. To date, limited data are available from either observations of the general population\u003csup\u003e3,7\u003c/sup\u003e or retrospective data from patients who underwent surgical treatment\u003csup\u003e4\u003c/sup\u003e. Consistent with previous studies\u003csup\u003e3,4,7\u003c/sup\u003e, our results in Chinese preschool children show that younger individuals have a higher risk of epiblepharon, supporting the widely-accepted hypothesis that epiblepharon tends to disappear spontaneously with aging as facial bone growth in Asians\u003csup\u003e6\u003c/sup\u003e. However, there are discrepancies in BMI and the sexual predilection between our study and others. Different from results in Japanese and Singaporeans where no sexual predilection was recognized\u003csup\u003e3,4,7\u003c/sup\u003e, the present study demonstrates that boys are subject to a higher risk of having lower eyelid epiblepharon than girls with an adjusted OR = 1.41 in the logistic regression model. Differences in the diagnostic criteria\u003csup\u003e3\u003c/sup\u003e, subjects\u0026rsquo; age range\u003csup\u003e7\u003c/sup\u003e, epiblepharon severity, and possible sample selection bias in a clinic-based study\u003csup\u003e4\u003c/sup\u003e may all contribute to the discrepancy in sex predilection between our study and others.\u003c/p\u003e\n\u003cp\u003eAlthough lower eyelid epiblepharon trends to resolve spontaneously with aging, its occurrence during the critical period of visual development makes it crucial to disclose if it is correlated with refractive errors, which may ultimately lead to permanent visual impairment such as amblyopia or retinopathy\u003csup\u003e14-17\u003c/sup\u003e. In this study, the prevalence of astigmatism was 9.68%, similar to previous studies in Asian infants and preschoolers\u003csup\u003e18-20\u003c/sup\u003e, and, in those with lower eyelid epiblepharon, the prevalence could be as high as 18.9%. We demonstrate for the first time that epiblepharon children are subject to a significantly higher risk of astigmatism, largely being WTR in the general population, and these findings agree well with previous retrospective studies in patients\u003csup\u003e9,11,12\u003c/sup\u003e. In addition, we also evaluated the relationship between lower eyelid epiblepharon and spherical refractive errors, i.e., myopia and hyperopia. These epiblepharon preschoolers were 3.55 times as likely to have myopia as those without epiblepharon, and 1.53 times as likely to have hyperopia. The significantly increased risk of myopia in epiblepharon children agrees with the observations in clinical patients that severe myopia is commonly accompanied by a large number of cilia touching the cornea\u003csup\u003e9\u003c/sup\u003e. However, considering the relatively small sample size (22 out of 39 epiblepharon preschoolers being myopic) and absence of severe myopia (-2.75 D to -0.5 D), further study with a larger sample size should be conducted to further validate the association between epiblepharon and myopia.\u003c/p\u003e\n\u003cp\u003eThe strength of this study lies in the fact that the demographics of epiblepharon and its association with refractive errors are evaluated in the Chinese preschool population with by far the largest sample size thus far reported. Nevertheless, there are several limitations in this study. First, the children included in this study were all enrolled from urban areas, which may result in bias from sample selection. Further studies ideally from multiple centers including children from both rural and urban area would improve our understanding of the risk factors related to lower eyelid epiblepharon and its association with refractive errors. Second, the prevalence of epiblepharon may be underestimated because epiblepharon can be missed in children whose cilia touch the cornea only in downward gaze but not in primary gaze. Another limitation is that we used only the skinfold height and the cilia-cornea touching area as criteria for the diagnosis of lower eyelid epiblepharon without considering areas of corneal erosion. However, owing to concerns about the risk of the fluorescein dying procedure and limited time allowance in a screening circumstance, an approach that is both safe and simple must be adopted; in addition, this limitation can be mitigated since there is high agreement among the three criteria for the diagnosis of epiblepharon\u003csup\u003e8\u003c/sup\u003e. In addition, our conclusion may be affected by type 1 error as multiple comparisons were conducted.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study demonstrates a relatively high prevalence of lower eyelid epiblepharon in Chinese preschoolers, particularly in boys and young children, and shows that there are significant correlations between lower eyelid epiblepharon and refractive errors, including astigmatism, myopia, and hyperopia. Given such a high prevalence combined with the increased risk for refractive errors, it would be of great significance to be aware of the necessity and importance to establish an effective screening strategy for this disease, to conduct a closer follow-up of the clinical manifestations of involved children and to consider giving early interventions and visual rehabilitation when warranted.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAORs: adjusted odds ratios\u003c/p\u003e\n\u003cp\u003eORs: odds ratios\u003c/p\u003e\n\u003cp\u003eCIs: confidence intervals\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e\n\u003cp\u003eSD: standard deviation\u003c/p\u003e\n\u003cp\u003eSE: spherical equivalent refractive error\u003c/p\u003e\n\u003cp\u003eCYL: cylindrical refractive error\u003c/p\u003e\n\u003cp\u003eWTR: with-the-rule\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;ATR: against-the-rule\u003c/p\u003e\n\u003cp\u003eOBL: oblique\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures conformed to the tenets of the declaration of Helsinki and written informed consent was obtained from the parents or guardians of the participants. The Ethics Committee\u0026nbsp;of Beijing Shijitan Hospital approved the study (2017 Research ethics NO.69, Beijing Shijitan Hospital, Affiliated to Capital Medical University, 2017-5-20).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo authors have conflict of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;was\u0026nbsp;supported by the Ministry of Education Singapore under its Academic Research Fund Tier 1 (2018-T1-001-144), Agency for Science, Technology and Research (A*STAR) under its Industrial Alignment Fund (Pre-positioning) (H17/01/a0/008),\u0026nbsp;National Medical Research Council Singapore under its Open Fund - Individual Research Grant (MOH-OFIRG19may-0009), and\u0026nbsp;Beijing\u0026nbsp;Shijitan Hospital, Capital Medical University\u0026nbsp;under its Hospital Fund (2017-C07). The Funding sponsors were not involved in the study design, data analysis, results interpretation, or manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXL\u0026nbsp;and LL\u0026nbsp;designed\u0026nbsp;and\u0026nbsp;supervised this study. ZD, CS and RX collected data. ZD, CS and LL conducted data analysis and interpretation. CS and ZD drafted the manuscript. RX, WB, and XL provided administrative, technical, and material support for this study. All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all subjects for participating in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJohnson CC. Epiblepharon. \u003cem\u003eAmerican journal of ophthalmology. \u003c/em\u003eDec 1968;66(6):1172-1175.\u003c/li\u003e\n\u003cli\u003eLemke BN, Stasior OG. Epiblepharon. An important and often missed diagnosis. \u003cem\u003eClinical pediatrics. \u003c/em\u003eOct 1981;20(10):661-662.\u003c/li\u003e\n\u003cli\u003eNoda S, Hayasaka S, Setogawa T. Epiblepharon with inverted eyelashes in Japanese children. I. Incidence and symptoms. \u003cem\u003eBr J Ophthalmol. \u003c/em\u003eFeb 1989;73(2):126-127.\u003c/li\u003e\n\u003cli\u003eSundar G, Young SM, Tara S, Tan AM, Amrith S. Epiblepharon in East asian patients: the singapore experience. \u003cem\u003eOphthalmology. \u003c/em\u003eJan 2010;117(1):184-189.\u003c/li\u003e\n\u003cli\u003eYan Y, Chen T, Wei W, Li D. Epiblepharon in Chinese children: relationships with body mass index and surgical treatment. \u003cem\u003eJ AAPOS. \u003c/em\u003eApr 2016;20(2):148-152.\u003c/li\u003e\n\u003cli\u003eKim JS, Jin SW, Hur MC, et al. The clinical characteristics and surgical outcomes of epiblepharon in korean children: a 9-year experience. \u003cem\u003eJournal of ophthalmology. \u003c/em\u003e2014;2014:156501.\u003c/li\u003e\n\u003cli\u003eHayasaka Y, Hayasaka S. Epiblepharon with inverted eyelashes and high body mass index in Japanese children. \u003cem\u003eJ Pediatr Ophthalmol Strabismus. \u003c/em\u003eSep-Oct 2005;42(5):300-303.\u003c/li\u003e\n\u003cli\u003eKhwarg SI, Lee YJ. Epiblepharon of the lower eyelid: classification and association with astigmatism. \u003cem\u003eKorean J Ophthalmol. \u003c/em\u003eDec 1997;11(2):111-117.\u003c/li\u003e\n\u003cli\u003eYang SW, Choi WC, Kim SY. Refractive changes of congenital entropion and epiblepharon on surgical correction. \u003cem\u003eKorean J Ophthalmol. \u003c/em\u003eJun 2001;15(1):32-37.\u003c/li\u003e\n\u003cli\u003eAhn HB, Seo JW, Yoo JH, Jeong WJ, Park WC, Rho SH. Epiblepharon related to high body mass index in Korean children. \u003cem\u003eJ Pediatr Ophthalmol Strabismus. \u003c/em\u003eJan-Feb 2011;48(1):57-60.\u003c/li\u003e\n\u003cli\u003ePreechawai P, Amrith S, Wong I, Sundar G. Refractive changes in epiblepharon. \u003cem\u003eAm J Ophthalmol. \u003c/em\u003eMay 2007;143(5):835-839.\u003c/li\u003e\n\u003cli\u003eShih MH, Huang FC. Astigmatism in children with epiblepharon. \u003cem\u003eCornea. \u003c/em\u003eOct 2007;26(9):1090-1094.\u003c/li\u003e\n\u003cli\u003eYoung SM, Kim YD, Woo KI. Modified everting sutures: an alternative treatment for mild to moderate epiblepharon. \u003cem\u003eThe British journal of ophthalmology. \u003c/em\u003eNov 2018;102(11):1510-1514.\u003c/li\u003e\n\u003cli\u003eWoo KI, Kim YD. Management of epiblepharon: state of the art. \u003cem\u003eCurr Opin Ophthalmol. \u003c/em\u003eSep 2016;27(5):433-438.\u003c/li\u003e\n\u003cli\u003eXiao O, Guo X, Wang D, et al. Distribution and Severity of Myopic Maculopathy Among Highly Myopic Eyes. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science. \u003c/em\u003eOct 1 2018;59(12):4880-4885.\u003c/li\u003e\n\u003cli\u003eZiylan S, Yabas O, Zorlutuna N, Serin D. Isoametropic amblyopia in highly hyperopic children. \u003cem\u003eActa ophthalmologica Scandinavica. \u003c/em\u003eFeb 2007;85(1):111-113.\u003c/li\u003e\n\u003cli\u003eXiao O, Morgan IG, Ellwein LB, He M, Refractive Error Study in Children Study G. Prevalence of Amblyopia in School-Aged Children and Variations by Age, Gender, and Ethnicity in a Multi-Country Refractive Error Study. \u003cem\u003eOphthalmology. \u003c/em\u003e2015;122(9):1924-1931.\u003c/li\u003e\n\u003cli\u003eDirani M, Chan YH, Gazzard G, et al. Prevalence of refractive error in Singaporean Chinese children: the strabismus, amblyopia, and refractive error in young Singaporean Children (STARS) study. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science. \u003c/em\u003eMar 2010;51(3):1348-1355.\u003c/li\u003e\n\u003cli\u003eWen G, Tarczy-Hornoch K, McKean-Cowdin R, et al. Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. \u003cem\u003eOphthalmology. \u003c/em\u003eOct 2013;120(10):2109-2116.\u003c/li\u003e\n\u003cli\u003eLan W, Zhao F, Lin L, et al. Refractive errors in 3-6 year-old Chinese children: a very low prevalence of myopia? \u003cem\u003ePloS one. \u003c/em\u003e2013;8(10):e78003.\u003c/li\u003e\n\u003cli\u003eRead SA, Collins MJ, Carney LG. A review of astigmatism and its possible genesis. \u003cem\u003eClinical \u0026amp; experimental optometry. \u003c/em\u003eJan 2007;90(1):5-19.\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"lower eyelid epiblepharon, astigmatism, myopia, refractive error, preschool children","lastPublishedDoi":"10.21203/rs.3.rs-51866/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-51866/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTo assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this population-based, cross-sectional study, a total of 3,170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external\u0026nbsp;eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6%, 28.0%, 15.0%, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20-1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68-4.33)), myopia (OR = 3.55; 95% CI, (1.86-6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18-1.99)). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThere is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population.\u003c/p\u003e","manuscriptTitle":"The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-12-07 16:24:00","doi":"10.21203/rs.3.rs-51866/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2020-11-28T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-11-25T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-11-24T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-24T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-10-26 18:01:18","doi":"10.21203/rs.3.rs-51866/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2020-11-12T00:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\n1. There are grammar errors throughout the text necessitating editing by a native speaker or a professional in the English language.\n2.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. 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(default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"decision","content":"Minor revision","date":"2020-11-12T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-06T00:00:00+00:00","index":1,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-11-04T00:00:00+00:00","index":2,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-10-19T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-10-19T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-19T12:00:00+00:00","index":1,"fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-18T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-18T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-08-11 15:38:36","doi":"10.21203/rs.3.rs-51866/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-09-17T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-09-08T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThis is an interesting manuscript on the population-based prevalence of lower eyelid epiblepharon in a Chinese kindergarten population. Although the study is certainly interesting, there are some issues with the data analysis and the reviewer feels the data and the findings may have been overly extrapolated. Overall, I suggest the authors simplify their data analysis and focus on epiblepharon vs no epiblepharon particularly when assessing the risk factors. Below are my specific comments.\n\nMajor comments:\n\n1. For a margin error of 2%, a confidence interval of 95%, and an expected prevalence of 10%, my computed sample size is 857. Please clarify.\n\n2. Line 139: A multivariate logistic regression analysis assesses the simultaneous association of multiple dependent variables against multiple independent variables. Since the association sought in this analysis is the presence of lower eyelid epiblepharon (outcome) vs other predictors I reckon that it should be named multivariable logistic regression analysis. This type of analysis looks at the association and not correlation (as depicted in Line 140 and table 3 \u0026 4 headers/captions), so please revise.\n\n3. There is a significant issue with the logistic regression analysis. First and foremost, some of the cells in table 1 have very few numbers making it impossible to do a logistic regression analysis after all. Also, there are multiple comparisons in Table 4 entailing the possibility of a type I error.\n\n4. How were multiple comparisons adjusted for? It is also more appropriate if the authors could report all p values instead of just iterating that the data is statistically significant at p level \u003c0.05. I suggest that the analysis in Table 4 may be truncated to just epiblepharon vs no epiblepharon or no epiblepharon vs 3 severity levels of epiblepharon at most.\n\n5. There is no correction for multiple comparisons in any of the statistical tests. This is a significant issue particularly in instances where the result is only marginally significant (e.g. mean astigmatism in subcategories of epiblepharon).\n\n6. Line 142: what were the potential confounders that were adjusted for?\n\n7. How was multicollinearity accounted for in the logistic regression analyses?\n\n8. The Discussion section needs to be revisited and possibly shortened after simplification of the overall analysis.\n\nMinor comments:\n\n1. The wording \"oriental(s)\" may be substituted with \"Asian populations\", which is more appropriate.\n\n2. There are grammar errors (tense errors etc.) throughout the text necessitating editing by a native speaker or a professional in the English language.\n\n3. The response rate is 85.2% but the total normal of invited individuals had not been given. If 3721 children completed all the examinations, then why is there data of only 3170 individuals?\n\n4. Lines 102, 114, 123, and 125: this is only individual samples t-test and not Pearson's t-test. There is Pearson's chi-squared test and Pearson's correlation.\n\n5. There is no assessment of BMI vs presence of epiblepharon in Table 3 as stated in Lines 138 - 141.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. 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Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-08-24T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-08-15T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-08-13T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-08-10T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-08-10T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-08-05T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0484100b-40d7-4b94-a5e3-db2e932ce88b","owner":[],"postedDate":"December 7th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":889437,"name":"Ophthalmology"},{"id":889438,"name":"Pediatrics"}],"tags":[],"updatedAt":"2021-01-10T15:05:44+00:00","versionOfRecord":{"articleIdentity":"rs-51866","link":"https://doi.org/10.1186/s12886-020-01749-7","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2021-01-04 15:01:53","publishedOnDateReadable":"January 4th, 2021"},"versionCreatedAt":"2020-12-07 16:24:00","video":"","vorDoi":"10.1186/s12886-020-01749-7","vorDoiUrl":"https://doi.org/10.1186/s12886-020-01749-7","workflowStages":[]},"version":"v3","identity":"rs-51866","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-51866","identity":"rs-51866","version":["v3"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}