Floppy Eyelid Syndrome
Floppy eyelid syndrome is characterized by ocular irritation, redness, eyelash ptosis, loss of eyelash parallelism, and mild mucus discharge that is frequently worse on awakening (Fig 10-19). Patients have chronic papillary conjunctivitis and a superior tarsal plate that is rubbery, flaccid, and easily everted. Histologic examination has demonstrated a marked decrease in the number of elastin fibers within the tarsus. During examination, the lax upper eyelid everts spontaneously, especially laterally, when pulled up toward the forehead. Patients often report sleeping in a prone position, which can cause mechanical upper eyelid eversion, with the superior palpebral conjunctiva rubbing against the pillow or bedding. Associations have been reported with obesity, sleep apnea, keratoconus, eyelid rubbing, and hyperglycemia. Sleep studies are recommended to rule out sleep apnea.
Initial conservative treatment consists of viscous lubrication and a patch or shield at night. Surgical correction, if warranted, consists of wedge resection and horizontal eyelid tightening. If the patient has been diagnosed with sleep apnea, use of a continuous positive airway pressure device may reduce prone position sleeping and minimize recurrence after surgical correction.
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Ezra DG, Beaconsfield M, Sira M, et al. Long-term outcomes of surgical approaches to the treatment of floppy eyelid syndrome. Ophthalmology. 2010;117(4):839–846.
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.