From the Guidelines
Floppy eyelid syndrome is a condition that is indeed linked to snoring and obstructive sleep apnea, and its management should prioritize addressing any underlying sleep disorders. The syndrome is characterized by extremely loose and rubbery upper eyelids that can easily flip over, even during sleep, leading to chronic eye irritation, redness, discharge, and a sensation of something in the eye, particularly upon waking 1. These symptoms occur because the loose eyelid turns inside out during sleep, exposing the inner eyelid surface to friction against pillows or bedding.
Key Characteristics and Associations
- Floppy eyelid syndrome is more common in overweight middle-aged men and is strongly associated with sleep disorders, including obstructive sleep apnea and snoring.
- The condition has also been linked to keratoconus and obesity, suggesting a complex interplay of factors contributing to its development and progression 1.
- Patients with floppy eyelid syndrome may benefit from consultations with specialists, including oculoplastics specialists for the management of the eyelid condition itself, and other medical specialists for associated conditions like obstructive sleep apnea.
Management and Treatment
- Treatment begins with lubricating eye drops and ointments, particularly at bedtime, along with taping the eyelids closed or using eye shields during sleep to prevent the eyelid from flipping over 1.
- Addressing any underlying sleep apnea is crucial, often requiring CPAP therapy, as this can help reduce the severity of floppy eyelid syndrome symptoms.
- For persistent cases, surgical intervention may be necessary to tighten the eyelids, procedures such as lateral canthus repair, horizontal shortening of the upper eyelid, or excision of the medial upper lid may be considered 1.
- Weight loss can help improve both floppy eyelid syndrome and sleep apnea by reducing pressure on the airway and decreasing tissue laxity throughout the body.
Lifestyle Modifications
- While lifestyle changes such as avoiding eye rubbing have been suggested to prevent progression in related conditions like keratoconus, their direct impact on floppy eyelid syndrome is less clear 1.
- However, given the associations between floppy eyelid syndrome, sleep disorders, and obesity, promoting healthy lifestyle choices, including weight management and good sleep hygiene, is likely beneficial for overall health and may help mitigate symptoms of floppy eyelid syndrome.
From the Research
Definition and Characteristics of Floppy Eyelid Syndrome
- Floppy eyelid syndrome (FES) 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 2
- FES is frequently associated with ocular and systemic diseases, notably keratoconus and obstructive sleep apnea, respectively 2
Association with Obstructive Sleep Apnea and Snoring
- FES is associated with obstructive sleep apnea (OSA) syndrome 3, 4, 5
- Snoring is a common symptom of OSA, which is linked to FES 3
- Studies have shown that patients with FES and OSA may experience improvement in their ocular signs and symptoms after long-term therapy with continuous positive airway pressure (CPAP) 2, 3, 4
Diagnosis and Treatment
- Diagnostic strategies for FES include thorough clinical examinations and specific tests for an efficacious grading and assessment of FES 6
- Management of FES ranges from conservative medical treatments to surgical interventions for more severe cases 2, 6
- CPAP therapy has been shown to reverse FES in some patients, particularly those with less severe OSA 4
Epidemiology and Pathophysiology
- FES is a common condition that can be associated with significant ocular irritation 2
- The exact pathophysiology of FES is not fully understood, but it is thought to be related to the abnormal laxity of the upper eyelids 6
- Genetic predispositions and associations with ocular and systemic conditions such as obesity, keratoconus, and glaucoma may contribute to the development of FES 6