Floppy Eyelid Syndrome
Floppy eyelid syndrome is an ophthalmic disorder consisting of chronic ocular irritation and inflammation and characterized by a lax upper tarsus that everts with minimal upward force applied to the upper eyelid. The syndrome is most frequently seen in obese individuals, who often have obstructive sleep apnea. Clinical findings include small to large papillae on the upper palpebral conjunctiva, mucous discharge, and corneal involvement ranging from mild punctate epitheliopathy to superficial vascularization (Fig 4-2). Keratoconus has also been reported in patients with floppy eyelid syndrome. The problem may result from spontaneous eversion of the upper eyelid when it comes into contact with the pillow or other bed linens during sleep. This may result in trauma to the upper tarsal conjunctiva, inducing inflammation and chronic irritation. The condition is most often bilateral but can be asymmetric or unilateral if the patient always sleeps on the same side. Common symptoms include redness, foreign-body sensation, and mucous discharge most prominent upon waking. The differential diagnosis includes vernal conjunctivitis, giant papillary conjunctivitis, atopic keratoconjunctivitis, bacterial conjunctivitis, and toxic keratopathy. Treatment consists of covering the affected eye with a shield, taping the eyelids closed at night, or performing a surgical procedure to tighten the upper eyelid. See also BCSC Section 7, Oculofacial Plastic and Orbital Surgery.
Figure 4-2 Floppy eyelid syndrome with a papillary response on the superior tarsus.
(Courtesy of Vincent P. deLuise, MD.)
Pham TT, Perry JD. Floppy eyelid syndrome. Curr Opin Ophthalmol. 2007;18(5):430–433.
Stern GA. Chronic conjunctivitis, Parts 1–2. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 2012, modules 11–12.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.