Floppy eyelid syndrome
Introduction
Floppy eyelid syndrome is an very rare unilateral or bilateral condition that's often overlooked as a explanation for persistent ocular surface symptoms.
It typically affects obese middle-aged and older men who roll in the hay one or both eyelids against the pillow, resulting in pulling of the lid faraway from the world ; consequent nocturnal exposure and poor contact with the globe, often exacerbated by other ocular surface disease like dry eye and blepharitis, end in chronic keratoconjunctivitis.
Obstructive sleep apnoea (OSA) is strongly associated; OSA is linked tosignificant morbidity, including cardiopulmonary disease and subtle but irreversible mental dysfunction and/or excessive daytime sleepiness.
Significant morbidity, including cardiopulmonary disease and subtle but irreversible mental dysfunction.
Diagnosis
• The upper eyelid is usually extremely lax, often with substantial excess loose upper lid skin. The tarsal plate features a rubbery consistency, the lid is extremely easy to Evert, to fold and to tug away from the eye.
• Papillary conjunctivitis of the superior tarsal conjunctiva could also be intense.
• Keratopathy Punctate keratopathy, filamentary keratitis and superior superficial vascularization could also be present.
• Other findings may include eyelash ptosis, lachrymal gland prolapse, ectropion and aponeurotic ptosis. Patients with both FES and OSA seem to possess a considerably higher thanaverage prevalence of glaucoma.
• Investigation for OSA should be considered in most cases of FES, particularly if the patient reports substantial snoring and/or excessive daytime sleepiness.
Treatment
• Treatment of associated OSA is probably going to be of benefit; overweight patients should be encouraged to reduce .
• Mild cases may answer lubrication along side nocturnal eye shield wear or taping of the lids.
• Moderate to severe cases require horizontal shortening to stabilize the lid and ocular surface and stop nocturnal lag ophthalmos; a pentagonal excision of 10 mm or more is taken from the junction of the lateral third and medial two-thirds of the upper lid.