Prospective Evaluation of Floppy Eyelid Syndrome at Baseline and after CPAP Therapy

Vieira, Maria João; Silva, Maria João; Lopes, Nádia; Moreira, Cláudia; Carvalheira, Fausto; Sousa, João Paulo

doi:10.1080/02713683.2020.1776332

Cited by 12 publications

(7 citation statements)

References 23 publications

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“…[93][94][95][96][97] While treating OSA has been suggested to reduce the risk of or even reverse FES, 4,5 no randomised or nonrandomised controlled trials have been published to support this. Viera et al 98 observed 34 patients with newlydiagnosed OSA and FES and found that FES was reversed in about half of the patients after 6 months of CPAP therapy. However, the lack of a control group in the study renders its evidence inconclusive.…”

Section: Floppy Eyelid Syndrome and Corneal Changesmentioning

confidence: 99%

Sleep and eye disease: A review

Lee

Nilagiri

Mackey

2022

Clinical Exper Ophthalmology

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There is a growing body of literature on the effects of sleep disorders, in particular obstructive sleep apnoea (OSA), on ocular health, with consistent evidence of an increased risk of floppy eyelid syndrome, non-arteritic anterior ischaemic optic neuropathy, diabetic macular oedema, and other retinal vasculature changes in individuals with OSA. However, reports on OSA's associations with glaucoma, papilloedema, diabetic retinopathy, central serous chorioretinopathy, and keratoconus have been conflicting, while links between OSA and age-related macular degeneration have only been described fairly recently. Despite numerous suggestions that OSA treatment may reduce risk of these eye diseases, well-designed studies to support these claims are lacking. In particular, the ocular hypertensive effects of continuous positive airway pressure (CPAP) therapy for OSA requires further investigation into its potential impact on glaucoma risk and management. Reports of ocular surface complications secondary to leaking CPAP masks highlights the importance of ensuring good mask fit. Poor sleep habits have also been linked with increased myopia risk; however, the evidence on this association remains weak.

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Section: Floppy Eyelid Syndrome and Corneal Changesmentioning

confidence: 99%

Sleep and eye disease: A review

Lee

Nilagiri

Mackey

2022

Clinical Exper Ophthalmology

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“…The treatment involves eye shields, taping the eyelids during the night, topical lubricants or ointments, and the patient should be encouraged not to rub his or her eyelids, as this may exacerbate the lid laxity. 1,2 Recently, Vieira et al 41 demonstrated that the CPAP therapy might reverse FES and patients with non-reversible FES appear to have more severe OSAHS and a worse airway access.…”

Section: Medical Therapymentioning

confidence: 99%

“…Recently, Vieira et al 41 demonstrated that the CPAP therapy might reverse FES and patients with non-reversible FES appear to have more severe OSAHS and a worse airway access.…”

Section: Therapymentioning

confidence: 99%

Floppy eyelid, an under-diagnosed syndrome: a review of demographics, pathogenesis, and treatment

et al. 2021

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Floppy eyelid syndrome (FES) is a frequent eyelid disorder characterized by eyelid laxity that determines a spontaneous eyelid eversion during sleep associated with chronic papillary conjunctivitis and systemic diseases. FES is an under-diagnosed syndrome for the inaccuracy of definition and the lack of diagnostic criteria. Eyelid laxity can result from a number of involutional, local, and systemic diseases. Thus, it is pivotal to use the right terminology. When the increased distractibility of the upper or lower eyelid is an isolated condition, it is defined as ‘lax eyelid condition’ (LAC). When laxity is associated with ocular surface disorder such as papillary conjunctivitis and dry eyes, it can be referred to as ‘lax eyelid syndrome’ (LES). However, FES is characterized by the finding of a very loose upper eyelid which everts very easily and papillary tarsal conjunctivitis affecting a specific population of patients, typically male, of middle age and overweight. Obesity in middle-aged male is also recognized as the strongest risk factor in obstructive sleep apnea-hypopnea syndrome, (OSAHS). FES has been reported as the most frequent ocular disorder associated with OSAHS. Patients with FES often complain of non-pathognomonic ocular signs and symptoms such as pain, foreign body sensation, redness, photophobia, and lacrimation. Due to these clinical features, FES is often misdiagnosed while an early recognition might be important to avoid its chronic, distressing course and the associated morbidities. This review provides an updated overview on FES by describing the epidemiology, proposed pathogenesis, clinical manifestations, related ocular, and systemic diseases, and treatment options.

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“…Therapeutic approaches that could mitigate these structural changes to the tissues would potentially benefit patients with either FES or OSA. However, a more functional interrelationship between these two conditions has been suggested by several studies that reported that FES improved in a group of OSA patients with successful use of CPAP [18,19]. The not-soclear-cut effects of CPAP therapy and OSA-related surgery on FES suggest that both shared factors related to the structural integrity of the palate and lid tissues, as well as dynamic features of OSA, can impact FES directly.…”

Section: Eyelid and Ocular Surface Morphologymentioning

confidence: 99%

The Associations of Obstructive Sleep Apnea and Eye Disorders: Potential Insights into Pathogenesis and Treatment

Ahn

Gorin²

2021

Curr Sleep Medicine Rep

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Purpose of Review Obstructive sleep apnea (OSA) patients are at significantly increased risks for cardiovascular and cerebrovascular morbidities. Recently, there has been heightened interest in the association of OSA with numerous ocular diseases and possible improvement of these conditions with the initiation of OSA treatment. We reviewed the current evidence with an emphasis on the overlapping pathogeneses of both diseases. Recent Findings Currently available literature points to a substantial association of OSA with ocular diseases, ranging from those involving the eyelid to optic neuropathies and retinal vascular diseases. Since the retina is one of the highest oxygen-consuming tissues in the body, the intermittent hypoxia and hypercapnia ensuing in OSA can have deleterious effects on ocular function and health. Tissue hypoxia, autonomic dysfunction, microvascular dysfunction, and inflammation all play important roles in the pathogenesis of both OSA and ocular diseases. Whether OSA treatment is capable of reversing the course of associated ocular diseases remains to be determined. It is anticipated that future therapeutic approaches will target the common underlying pathophysiologic mechanisms and promote favorable effects on the treatment of known associated ocular diseases. Summary Emerging evidence supports the association of ocular diseases with untreated OSA. Future studies focusing on whether therapeutic approaches targeting the common pathophysiologic mechanisms will be beneficial for the course of both diseases are warranted.

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Prospective Evaluation of Floppy Eyelid Syndrome at Baseline and after CPAP Therapy

Cited by 12 publications

References 23 publications

Sleep and eye disease: A review

Sleep and eye disease: A review

Floppy eyelid, an under-diagnosed syndrome: a review of demographics, pathogenesis, and treatment

The Associations of Obstructive Sleep Apnea and Eye Disorders: Potential Insights into Pathogenesis and Treatment

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