Floppy eyelid syndrome: review

Abstract

RESUMOA síndrome de frouxidão palpebral é caracterizada pela fácil eversão da pálpebra que ocorre espontaneamente durante o sono causando exposição dos olhos, com consequente conjuntivite papilar crônica. Sua patogênese ainda não está totalmente definida e é mais comum em pacientes masculinos, obesos, de meia idade e está associada a doenças sistêmicas como apnéia obstrutiva do sono, hipertensão arterial e diabetes. Quando o tratamento clínico não apresenta boa resposta, procedimentos cirúrgicos apresentam bons resultados, com técnicas em constante evolução.Descritores: Conjuntiva/patologia; Conjuntivite; Ectrópio; Obesidade/complicações; Hipertensão/complicações; Diabete Mellitus/complicações; Apnéia do sono tipo obstrutiva/complicações; Doenças palpebrais/cirurgia; Síndrome; Músculos oculomotores/cirurgia; Pálpebras/cirurgia; Doenças da córnea ABSTRACTFloppy eyelid syndrome is characterized by the easy evertion of the upper eyelid which occurs spontaneously during the sleep, causing the exposure of the eye surface and chronic papillary conjunctivitis. Its pathogenesis is not totally defined yet: it is usually more frequent in middle-aged, male obese patients and it is associated with systemic disorders such as obstructive sleep apnea, high blood pressure and diabetes. On the occasions which conservative treatment fails, surgical procedures present good results, including surgical techniques which are constantly evolving.

Ocular Manifestations of Obstructive Sleep Apnea

“…2 This leaves the eye susceptible to discomfort and visual symptoms related to exposure. In a study of 50 patients with FES, 96% experienced symptoms associated with OSA.…”

“…4 Miyamoto et al and McNab have also suggested that FES in patients with sleep apnea denotes a greater severity of disease. 2,3 Physicians caring for patients with suspected and/or known OSA may identify FES by asking about symptoms of ocular discomfort. Exposure symptoms related to FES may present as foreign body sensation, dryness, redness, or eyelid swelling.…”

“…FES histology reveals decreased elastin content and increased matrix metalloproteinase activity in lid connective tissue, demonstrating a similar connective tissue weakness. 2 Akin to the increased neck thickness in obstructive sleep apnea, patients with FES display tissue redundancy in the lateral canthal tendon. 2 Patients with FES often experience symptoms on the side on which they sleep, corroborating the theory of mechanical stress causing the syndrome.…”

“…2 Akin to the increased neck thickness in obstructive sleep apnea, patients with FES display tissue redundancy in the lateral canthal tendon. 2 Patients with FES often experience symptoms on the side on which they sleep, corroborating the theory of mechanical stress causing the syndrome. Lid histology in FES also reveals chronic inflammation with absent tissue atrophy.…”

Relation of Floppy Eyelid Syndrome with Obstructive Sleep Apnea

“…In general, patients with FES presents with nonspecific irritation, foreign body sensation, mucous discharge, dryness, redness, photosensitivity, eyelid swelling, and vision impairment (7). Although it has not been clearly understood yet, it has been reported to be associated with some systemic and ophthalmic diseases such as obesity, OSAS, ischemic heart disease, skin disorders, connective tissue disorders, corneal and eyelids abnormalities, glaucoma, and hypertension (8). A genetically predisposition, such as genetic abnormalities in collagen, elastin, or both, associated with age and sleeping patterns, have been also postulated.…”