Floppy Eyelid Syndrome: A Case Report
Abstract
Introduction: Floppy eyelid syndrome (FES) is an under-diagnosed unilateral or bilateral eyelid malposition.1 This was initially reported in 1981 by Culbertson and Ostler.2 Commonly involving the upper eyelids, it presents as recurrent or chronic ocular surface irritation and chronic papillary conjunctivitis of upper palpebral conjunctiva. Patients initially present with non-specific symptoms including eye irritation and a long history of unilateral or bilateral ocular redness and discharge.3 FES is frequently unrecognized cause of these non-specific symptoms and is noninfectious.3 Symptoms of FES are common to other diseases making it difficult to diagnose early.
FES result from eyelid laxity due to significant decrease in elastin content of the tarsal plate.2 This results in characteristic loose floppy eyelids with associated punctate epithelial keratopathy (PEK), ptosis of lateral eyelashes and typical conjunctival changes.2
It is associated with easy eversion of the upper lid which can flip open easily during sleep, predisposing to ocular surface exposure. Symptoms are severe on waking from sleep and patient may have obstructive sleep apnea.2
References
Orbit, Eyelid and Lacrimal system section 78. Basic and clinical science course, AAO, 2011- 2012
Culbertson WW, Ostler HB. The floppy eyelid syndrome. Am J Ophthalmol. 1981; 92(4):568- 569
Burkat CN, Lemke BN, Ophthal Plast Reconstr Surg. 2005; 21(1):52-58
McNab AA. Floppy eyelid syndrome and obstructive sleep apnea. Ophthal Plast ReconstrSurg. 1997 134(2):98-114.
Goldberg R, Seiff S, McFarland J, et al. Floppy eyelid syndrome and blepharochalasis. Am J Ophthalmol. 1986 102(3):376-381.
Donnenfeld ED, Perry HD, Gibraltar RP, et al. Keratoconus associated with floppy eyelid syndrome. Ophthalmology. 1991, 98(11): 1674-1678
