Floppy eyelid syndrome: Clinical features and the association with obstructive sleep apnea

Prevalence of Sleep Apnea Syndrome and High-Risk Characteristics Among Keratoconus Patients

“…10,11 Untreated obstructive sleep apnea is associated with increased risk of all-cause mortality and can lead to premature death. 12,13 Obstructive sleep apnea has been associated with a variety of ophthalmic conditions including glaucoma, 14,15 nonarteric ischemic optic neuropathy, 16,17 floppy eyelid syndrome, [18][19][20][21][22][23][24] retinal vein occlusion, 25 and keratoconus. [26][27][28][29] Floppy eyelid syndrome, a disorder marked by easily everted upper eyelids and papillary conjunctivitis, has also been linked to obstructive sleep apnea and keratoconus.…”

Relation of Floppy Eyelid Syndrome with Obstructive Sleep Apnea

“…Also, Acar et al (6) reported high rates and stages of FES in patients with advanced AHI scores in 280 patients in a sleep clinic, and explained the mechanism of tissue mechanic by hypoxemia. 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).…”

Floppy eyelid syndrome: review

“…Patients with this syndrome generally complain about nonspecific irritation, foreign body sensation, mucoid discharge, dryness, redness, photosensitivity, eyelid swelling and decreased vision (4)(5) . These symptoms are usually worse on awakening in the morning, and the affected side seems to correspond to the side the patient usually sleeps (1) .…”

“…Another theory claims that a combination of local pressure-induced lid ischemia and systemic hypoventilation followed by reperfusion oxidation injury during sleep (sleep apnea) is responsible for changes, such as chronic inflammation, which leads to higher temperature and lost of the normal barrier against water evaporation. This, in turn, would cause additional damage to the skin and this vicious cycle would aggravate lid inflammation, contributing to meibomian gland dysfunction, a condition that might be associated with FES (12) and lid floppiness (4) . The nonspecific ocular surface irritation related with FES might be due to abnormality in tear film dynamics.…”

“…There is a high correlation between the eye with worse symptoms with more severe floppy lids and the ocular surface evaporation rate. Tear film alterations is prevalent in patients with FES, most of them due to lipid tear deficiency (4) , which might be caused by abnormalities of meibomian glands (12) . Since the main finding in FES is the laxity of the lids, as the name of the syndrome suggests, it was postulated that alterations in collagen would explain this condition.…”