INTRODUCTION The Floppy Eyelid Syndrome primarily affects obese individuals with a male predominance.
The cause of the disease remains unknown and histological examination of the softened and redundant tarsal plate has not suggested any conclusive etiology. A mild chronic inflammatory infiltrate has been reported in some cases, but it is not clear if this was a primary cause or a secondary effect. The tarsal plate and skin show a decreased amount of elastin fibers. The syndrome and its clinical spectrum results from loss of physical integrity of the tarsus, perhaps in part related to habitual sleeping on the involved sides in patients with excessive weight. The condition is also associated with obstructive sleep apnea.
Floppy Eyelid Syndrome (Contd.)
CLINICAL CHARACTERISTICS More than 75% of patients with Floppy Eyelid Syndrome are males between the ages of 30 and 80 years. Obesity is a nearly constant finding, observed in 96% of cases. A history of sleeping on the face, especially on the involved side is typical. In most cases only the upper eyelid is involved, and in 60% of cases the condition is bilateral. Eyelash ptosis and loss of lash parallelism appear to be constant findings. Associated lower eyelid laxity is seen in 50% of affected patients, and in some a frank floppy lower eyelid will be present. Ocular symptoms include ptosis, ocular irritation, and foreign body sensation, especially upon waking up in the morning. Tear film deficiency is seen in most patients. Conjunctival injection, eyelid swelling, and a mucoid discharge are characteristics resulting from repeated nocturnal eyelid eversion. Chronic papillary conjunctivitis is typical with keratinization and epithelial thickening. Less commonly, superficial punctate keratopathy and a superior pannus result. The tarsus is soft and redundant, and shows marked laxity.
TREATMENT When the condition is mild topical lubrication combined with taping the eyelids closed at night, or applying an eye shield may provide some relief. In more severe cases, however, surgery will be needed. A full-thickness resection of the eyelid amounting to one-third to one-half of the horizontal length with primary layered closure is curative. This not only prevents spontaneous eyelid eversion during sleep, but also corrects the eyelid ptosis.
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