From the Guidelines
Fluffy eyelid syndrome, more formally known as floppy eyelid syndrome (FES), should be managed with a combination of conservative measures and surgical interventions, prioritizing the patient's clinical course and associated conditions such as obstructive sleep apnea, keratoconus, and obesity, as outlined in the most recent study 1. The condition is characterized by extremely loose and easily everted upper eyelids that can flip inside out during sleep, causing chronic eye irritation.
- Treatment typically begins with conservative measures including:
- Eye lubrication with artificial tears during the day and lubricating ointments at night
- Using a rigid eye shield or protective goggles during sleep to prevent eyelid eversion
- Taping the eyelids closed
- For those with associated obstructive sleep apnea (OSA), CPAP therapy is essential as treating the underlying sleep disorder often improves eyelid symptoms, as noted in the context of FES management 1.
- In persistent cases, surgical intervention including horizontal eyelid tightening procedures may be necessary, with options such as lateral canthus repair, horizontal shortening of the upper eyelid, or excision of the medial upper lid, as recommended in the most recent guidelines 1.
- Weight loss is also recommended for overweight patients as obesity is a risk factor for both FES and sleep apnea, highlighting the importance of a multidisciplinary approach to managing this condition 1.
From the Research
Definition and Symptoms of Fluffy Eyelid Syndrome
- Fluffy eyelid syndrome is also known as Floppy Eyelid Syndrome (FES), which is defined as eyelid hyperlaxity with reactive palpebral conjunctivitis 2.
- It is characterized by easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids.
- FES can cause significant ocular irritation, redness, and discomfort.
Associated Conditions
- FES is frequently associated with ocular and systemic diseases, such as keratoconus and obstructive sleep apnea 2, 3.
- Other associated conditions include obesity, glaucoma, and rosacea 3.
- Demodex blepharitis is another common condition that can cause similar symptoms, and it is essential to differentiate between the two conditions 4, 5, 6.
Treatment Options
- Conservative treatment of FES includes aggressive lubrication, nighttime eye shield, and avoiding sleeping on the affected eye 2.
- In refractory cases, corrective surgery can address the eyelid laxity and result in significant improvement 2, 3.
- For Demodex blepharitis, treatment options include topical ivermectin-metronidazole gel therapy, tea tree oil eyelid scrubs, and lotilaner ophthalmic solution 4, 5, 6.