From the Guidelines
Floppy eyelid syndrome is a condition characterized by extremely loose and rubbery upper eyelids that can easily flip over with minimal manipulation or during sleep, and its definitive therapy involves surgical procedures such as lateral canthus repair, horizontal shortening of the upper eyelid, or excision of the medial upper lid, as stated in the 2024 study published in Ophthalmology 1. The primary symptoms of floppy eyelid syndrome include eye irritation, redness, discharge, and a foreign body sensation, particularly upon waking, due to the loose eyelid turning inside out during sleep and causing chronic irritation and inflammation. Some key points about floppy eyelid syndrome are:
- It is often associated with obstructive sleep apnea, keratoconus, and obesity, as noted in the study published in Ophthalmology 1
- Initial treatment involves conservative measures such as eye lubricants, nighttime eye shields, and taping the eyelids closed during sleep
- Weight loss may help reduce symptoms in overweight patients
- For severe cases that don't respond to conservative treatment, surgical intervention to tighten the eyelids may be necessary, with procedures such as lateral canthus repair, horizontal shortening of the upper eyelid, or excision of the medial upper lid, as recommended in the 2024 study 1. The condition develops due to abnormalities in elastin fibers and collagen in the tarsal plate of the eyelid, causing the characteristic laxity and instability of the eyelid structure. Follow-up care depends on the patient’s clinical course, and providers may consider consultations with specialists, as suggested in the study published in Ophthalmology 1.
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 chronic eye irritation and an increased laxity of the upper eyelid that can be easily everted by applying minimal upward traction 3.
- FES presents with easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids 2.
- The syndrome is often associated with ocular and systemic diseases, notably keratoconus and obstructive sleep apnea, respectively 2, 3.
Clinical Features and Diagnosis
- Patients with FES often demonstrate unresolvable blepharoptosis, dermatochalasis, eyelash ptosis, entropion, or ectropion of the lower eyelid 3.
- The pathological course of FES can be worrisome because it is often associated with both ocular and systemic morbidities, most notably papillary conjunctivitis, keratoconus, and obstructive sleep apnea (OSA) 3, 4.
- Diagnostic strategies for FES include thorough clinical examinations and specific tests for an efficacious grading and assessment of FES 5.
Treatment Options
- Conservative treatment of FES includes aggressive lubrication, nighttime eye shield, and avoiding sleeping on the affected eye 2.
- Patients with FES and obstructive sleep apnea may have an improvement in their ocular signs and symptoms after long-term therapy with continuous positive airway pressure 2.
- Surgical intervention is often prompted if conservative measures give limited responses, with various blepharoplasty techniques proposed for FES, including full-thickness wedge excision of the tarsus, medial and lateral canthal ligament ligation, conchal cartilage graft, lateral tarsal strip with flap, and lateral tarsorrhaphy 3, 6.
- Early surgical intervention is encouraged if early diagnosis can be made, with high surgical success rates reported 3.